Provider Demographics
NPI:1629612288
Name:BIRCHFIELD, CHAQUINAIS DESHERRON (NP)
Entity Type:Individual
Prefix:MS
First Name:CHAQUINAIS
Middle Name:DESHERRON
Last Name:BIRCHFIELD
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 1:2104 GAUSE BLVD W STE A
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70460-4130
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:151 THAMES AVE
Practice Address - Street 2:
Practice Address - City:BAY ST LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520-5002
Practice Address - Country:US
Practice Address - Phone:985-643-4575
Practice Address - Fax:833-222-4520
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-06
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906151363LF0000X
LA232176363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily