Provider Demographics
NPI:1619544574
Name:VINCENT, CHRISTOPHER BLAINE (APRN)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:BLAINE
Last Name:VINCENT
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 BEVINGTON DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5443
Mailing Address - Country:US
Mailing Address - Phone:337-412-4506
Mailing Address - Fax:
Practice Address - Street 1:202 BEVINGTON DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5443
Practice Address - Country:US
Practice Address - Phone:337-412-4506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA220764363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology