Healthcare Provider Details

I. General information

NPI: 1629612288
Provider Name (Legal Business Name): CHAQUINAIS DESHERRON BIRCHFIELD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 THAMES AVE
BAY ST LOUIS MS
39520-5002
US

IV. Provider business mailing address

2104 GAUSE BLVD W STE A
SLIDELL LA
70460-4130
US

V. Phone/Fax

Practice location:
  • Phone: 985-643-4575
  • Fax: 833-222-4520
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number906151
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number232176
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: