Provider Demographics
NPI:1821086133
Name:CHARPENTIER, CHANTEL (FNP-C)
Entity Type:Individual
Prefix:
First Name:CHANTEL
Middle Name:
Last Name:CHARPENTIER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 N CANAL BLVD
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-8095
Mailing Address - Country:US
Mailing Address - Phone:985-446-6381
Mailing Address - Fax:985-446-5992
Practice Address - Street 1:931 N CANAL BLVD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-8095
Practice Address - Country:US
Practice Address - Phone:985-446-6381
Practice Address - Fax:985-446-5992
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP03960363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1141844Medicaid
LA4C595Medicare ID - Type Unspecified
LA1141844Medicaid