Provider Demographics
NPI:1831426477
Name:BURNS, CHANTEL K (MD)
Entity type:Individual
Prefix:
First Name:CHANTEL
Middle Name:K
Last Name:BURNS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8762 HIGHWAY 182
Mailing Address - Street 2:SOUTHWEST LOUISIANA PRIMARY HEALTHCARE CENTER
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-5603
Mailing Address - Country:US
Mailing Address - Phone:337-942-2005
Mailing Address - Fax:
Practice Address - Street 1:8762 HIGHWAY 182
Practice Address - Street 2:SOUTHWEST LOUISIANA PRIMARY HEALTHCARE CENTER
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-5603
Practice Address - Country:US
Practice Address - Phone:337-942-2005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA205751207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program