Provider Demographics
NPI:1154606234
Name:DARDAR, STACY RICARD (NP)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:RICARD
Last Name:DARDAR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 OCHSNER BLVD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-8107
Mailing Address - Country:US
Mailing Address - Phone:985-875-7007
Mailing Address - Fax:985-875-2730
Practice Address - Street 1:1000 OCHSNER BLVD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8107
Practice Address - Country:US
Practice Address - Phone:985-875-7007
Practice Address - Fax:985-875-2730
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06083363LF0000X
LARN107656363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2175513Medicaid
MS07806213Medicaid
LA3C8517061Medicare PIN