Provider Demographics
NPI:1225341019
Name:HEBERT, CHARMAINE LANDRY (NP)
Entity Type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:LANDRY
Last Name:HEBERT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:CHARMAINE
Other - Middle Name:LANDRY
Other - Last Name:CUCCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:337-470-3370
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:3220 KALISTE SALOOM RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508
Practice Address - Country:US
Practice Address - Phone:337-470-3370
Practice Address - Fax:337-470-4402
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06194363LF0000X
LARN075247 AP06194363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2121090Medicaid
LA2121090Medicaid