Provider Demographics
NPI:1386266187
Name:CAPDEPON, BELINDA BURSON
Entity type:Individual
Prefix:
First Name:BELINDA
Middle Name:BURSON
Last Name:CAPDEPON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2064 HIGHWAY 606
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:LA
Mailing Address - Zip Code:71366-4319
Mailing Address - Country:US
Mailing Address - Phone:318-341-2552
Mailing Address - Fax:
Practice Address - Street 1:104 VERONA STREET
Practice Address - Street 2:
Practice Address - City:NEWELLTON
Practice Address - State:LA
Practice Address - Zip Code:71357
Practice Address - Country:US
Practice Address - Phone:318-467-9949
Practice Address - Fax:318-467-2093
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP214091363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily