Healthcare Provider Details

I. General information

NPI: 1184634644
Provider Name (Legal Business Name): CHAD JOSEPH ACHORD CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15790 PAUL VEGA MD DR
HAMMOND LA
70403-1434
US

IV. Provider business mailing address

PO BOX 2668
HAMMOND LA
70404-2668
US

V. Phone/Fax

Practice location:
  • Phone: 985-230-6534
  • Fax: 985-230-6653
Mailing address:
  • Phone: 985-230-6534
  • Fax: 985-230-6653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN089101
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number16351
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP04882
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: