Healthcare Provider Details

I. General information

NPI: 1194904193
Provider Name (Legal Business Name): WILLIAM DUREAU DART JR. FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5439 AIRLINE HWY
BATON ROUGE LA
70805-1712
US

IV. Provider business mailing address

2051 SILVERSIDE DR SUITE 260
BATON ROUGE LA
70808-9005
US

V. Phone/Fax

Practice location:
  • Phone: 225-765-7163
  • Fax: 225-765-7164
Mailing address:
  • Phone: 225-490-6309
  • Fax: 225-765-9291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP05303
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP05303
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: