Healthcare Provider Details
I. General information
NPI: 1932778438
Provider Name (Legal Business Name): CHARON DERRAL BLANEY RN,MBA, DHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 06/21/2021
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:
III. Provider practice location address
4035 FLEET DR
BATON ROUGE LA
70809-2304
US
IV. Provider business mailing address
4035 FLEET DR
BATON ROUGE LA
70809-2304
US
V. Phone/Fax
- Phone: 225-716-1938
- Fax: 225-244-6165
- Phone: 225-716-1938
- Fax: 225-224-6165
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WA2000X |
| Taxonomy | Administrator Registered Nurse |
| License Number | RN082402 |
| License Number State | LA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC0400X |
| Taxonomy | Case Management Registered Nurse |
| License Number | RN082402 |
| License Number State | LA |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC1500X |
| Taxonomy | Community Health Registered Nurse |
| License Number | RN082402 |
| License Number State | LA |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WD0400X |
| Taxonomy | Diabetes Educator Registered Nurse |
| License Number | RN082402 |
| License Number State | LA |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WG0000X |
| Taxonomy | General Practice Registered Nurse |
| License Number | RN082402 |
| License Number State | LA |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WH0200X |
| Taxonomy | Home Health Registered Nurse |
| License Number | RN082402 |
| License Number State | LA |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WI0500X |
| Taxonomy | Infusion Therapy Registered Nurse |
| License Number | RN082402 |
| License Number State | LA |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WN1003X |
| Taxonomy | Nutrition Support Registered Nurse |
| License Number | RN082402 |
| License Number State | LA |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP0809X |
| Taxonomy | Adult Psychiatric/Mental Health Registered Nurse |
| License Number | RN082402 |
| License Number State | LA |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP2201X |
| Taxonomy | Ambulatory Care Registered Nurse |
| License Number | RN082402 |
| License Number State | LA |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 171400000X |
| Taxonomy | Health & Wellness Coach |
| License Number | RN082402 |
| License Number State | LA |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 171M00000X |
| Taxonomy | Case Manager/Care Coordinator |
| License Number | RN082402 |
| License Number State | LA |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 172V00000X |
| Taxonomy | Community Health Worker |
| License Number | RN082402 |
| License Number State | LA |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1744R1103X |
| Taxonomy | Research Study Abstracter/Coder |
| License Number | RN082402 |
| License Number State | LA |
| # 15 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 163W00000X |
| Taxonomy | Registered Nurse |
| License Number | RN082402 |
| License Number State | LA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
