Provider Demographics
NPI:1700808425
Name:BLANCHARD, PENNY WHITTINGTON (APRN, NNP)
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:WHITTINGTON
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:APRN, NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 RUE DE LA VIE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-5128
Mailing Address - Country:US
Mailing Address - Phone:225-928-2555
Mailing Address - Fax:225-929-9685
Practice Address - Street 1:500 RUE DE LA VIE
Practice Address - Street 2:SUITE 405
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-5128
Practice Address - Country:US
Practice Address - Phone:225-928-2555
Practice Address - Fax:225-929-9685
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP02587363LN0000X, 363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1131539Medicaid
4C396Medicare ID - Type Unspecified
P70822Medicare UPIN