Provider Demographics
NPI:1205811957
Name:HENDRICK, JOHN CHAPPELL (PA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CHAPPELL
Last Name:HENDRICK
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 1:4212 W CONGRESS ST
Mailing Address - Street 2:SUITE 3200
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-6765
Mailing Address - Country:US
Mailing Address - Phone:337-273-2863
Mailing Address - Fax:337-984-5428
Practice Address - Street 1:4212 W CONGRESS ST
Practice Address - Street 2:SUITE 3200
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-6765
Practice Address - Country:US
Practice Address - Phone:337-273-2863
Practice Address - Fax:337-984-5428
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA10268363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1624799Medicaid
LA970014804OtherRR MEDICARE
LAS64084Medicare UPIN
P00731923Medicare PIN
LA5DC90PA60Medicare PIN
LA1624799Medicaid