Healthcare Provider Details

I. General information

NPI: 1255368791
Provider Name (Legal Business Name): ALLEN R DARBONNE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 N HOSPITAL DR
ABBEVILLE LA
70510-4039
US

IV. Provider business mailing address

PO BOX 300087
AUSTIN TX
78703-0002
US

V. Phone/Fax

Practice location:
  • Phone: 337-893-5466
  • Fax:
Mailing address:
  • Phone: 512-407-7000
  • Fax: 855-267-8067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number04374
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: