Provider Demographics
NPI:1285662254
Name:DUPONT, PAMELA (NP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:DUPONT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4266 W MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:LA
Mailing Address - Zip Code:70359-6421
Mailing Address - Country:US
Mailing Address - Phone:985-856-7893
Mailing Address - Fax:985-873-0014
Practice Address - Street 1:4266 W MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:LA
Practice Address - Zip Code:70359-6421
Practice Address - Country:US
Practice Address - Phone:985-856-7893
Practice Address - Fax:985-873-0014
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN 040450163W00000X
LA04921363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse