Provider Demographics
NPI:1356462972
Name:DRUMMOND, MARK DEVIN (NPA)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:DEVIN
Last Name:DRUMMOND
Suffix:
Gender:M
Credentials:NPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1799
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-1799
Mailing Address - Country:US
Mailing Address - Phone:985-542-6251
Mailing Address - Fax:985-345-2386
Practice Address - Street 1:42388 PELICAN PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403
Practice Address - Country:US
Practice Address - Phone:985-542-6251
Practice Address - Fax:985-345-2386
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN080575163W00000X
LAAP05145363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
LARN080575OtherRN LICENSE
LAAP05145OtherNP LICENSE