Provider Demographics
NPI:1932778438
Name:BLANEY, CHARON DERRAL (RN,MBA, DHA)
Entity Type:Individual
Prefix:
First Name:CHARON
Middle Name:DERRAL
Last Name:BLANEY
Suffix:
Gender:F
Credentials:RN,MBA, DHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4035 FLEET DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-2304
Mailing Address - Country:US
Mailing Address - Phone:225-716-1938
Mailing Address - Fax:225-224-6165
Practice Address - Street 1:4035 FLEET DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2304
Practice Address - Country:US
Practice Address - Phone:225-716-1938
Practice Address - Fax:225-244-6165
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN082402163WA2000X, 163WC0400X, 163WC1500X, 163WD0400X, 163WG0000X, 163WH0200X, 163WI0500X, 163WN1003X, 163WP0809X, 163WP2201X, 171400000X, 171M00000X, 172V00000X, 1744R1103X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No171400000XOther Service ProvidersHealth & Wellness Coach
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No1744R1103XOther Service ProvidersSpecialistResearch Data Abstracter/Coder