Provider Demographics
NPI:1679543706
Name:COUVILLION, DARREN P (PA)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:P
Last Name:COUVILLION
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10101 PARK ROWE AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-1685
Mailing Address - Country:US
Mailing Address - Phone:225-769-0933
Mailing Address - Fax:225-769-5008
Practice Address - Street 1:5231 BRITTANY DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-9143
Practice Address - Country:US
Practice Address - Phone:225-769-0933
Practice Address - Fax:225-769-5008
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA10184363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CE22P657Medicare ID - Type Unspecified
LAS18262Medicare UPIN