Provider Demographics
NPI:1588944383
Name:DAUPHINEY, AFRICA BLACK (APRN)
Entity type:Individual
Prefix:MRS
First Name:AFRICA
Middle Name:BLACK
Last Name:DAUPHINEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 62504
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70596-2504
Mailing Address - Country:US
Mailing Address - Phone:337-454-3352
Mailing Address - Fax:337-454-3359
Practice Address - Street 1:3400 MOSS ST STE B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70507-6114
Practice Address - Country:US
Practice Address - Phone:337-454-3352
Practice Address - Fax:337-454-3359
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN120812163W00000X
LARN120812-AP06643363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3D060CA15OtherMEDICARE GROUP MEMBER PTAN
LA2181254Medicaid