Provider Demographics
NPI:1497112742
Name:DEDON, CHRISTOPHER DAVID (APRN)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DAVID
Last Name:DEDON
Suffix:
Gender:M
Credentials:APRN
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Mailing Address - Street 1:2335 CHURCH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-2700
Mailing Address - Country:US
Mailing Address - Phone:225-570-2489
Mailing Address - Fax:225-570-2986
Practice Address - Street 1:4801 MCHUGH RD
Practice Address - Street 2:SUITE C
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-5364
Practice Address - Country:US
Practice Address - Phone:225-570-2489
Practice Address - Fax:225-570-2986
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-18
Last Update Date:2020-01-26
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Provider Licenses
StateLicense IDTaxonomies
LAAPRN8568363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2434390Medicaid