Provider Demographics
NPI:1295307221
Name:CHAUMONT, MADALYN (FNP-C)
Entity type:Individual
Prefix:
First Name:MADALYN
Middle Name:
Last Name:CHAUMONT
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 1:555 DR MICHAEL DEBAKEY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5700
Mailing Address - Country:US
Mailing Address - Phone:337-439-0762
Mailing Address - Fax:337-436-8862
Practice Address - Street 1:555 DR MICHAEL DEBAKEY DR STE 101
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5700
Practice Address - Country:US
Practice Address - Phone:337-439-0762
Practice Address - Fax:337-436-8862
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA221146363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily