Provider Demographics
NPI:1720154461
Name:PRICE, DARRELL J (APRN FNPC)
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:J
Last Name:PRICE
Suffix:
Gender:M
Credentials:APRN FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 DOLPHIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTEGUT
Mailing Address - State:LA
Mailing Address - Zip Code:70377-2321
Mailing Address - Country:US
Mailing Address - Phone:504-579-2552
Mailing Address - Fax:
Practice Address - Street 1:843 MILLING AVE
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-4442
Practice Address - Country:US
Practice Address - Phone:985-785-5800
Practice Address - Fax:985-785-5811
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN071993363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1455229Medicaid
LA3A200Medicare PIN
LA1455229Medicaid