Provider Demographics
NPI:1588005003
Name:BLANCHARD, JEAN CLAUDE (NP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:CLAUDE
Last Name:BLANCHARD
Suffix:
Gender:M
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:PO BOX 4176
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70361-4176
Mailing Address - Country:US
Mailing Address - Phone:985-876-0300
Mailing Address - Fax:985-872-0317
Practice Address - Street 1:1320 MARTIN LUTHER KING DR
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4886
Practice Address - Country:US
Practice Address - Phone:985-446-2021
Practice Address - Fax:985-447-1546
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07462363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2348078Medicaid
LA318417YJQDMedicare PIN