Provider Demographics
NPI:1265106405
Name:WEBSTER, DAFFANEY J (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:DAFFANEY
Middle Name:J
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:DAFFANEY
Other - Middle Name:J
Other - Last Name:WEBSTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:PO BOX 66985
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70896-6985
Mailing Address - Country:US
Mailing Address - Phone:225-202-2875
Mailing Address - Fax:
Practice Address - Street 1:4303 PLANK RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-4134
Practice Address - Country:US
Practice Address - Phone:225-384-6124
Practice Address - Fax:225-256-0490
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA221452261QM0801X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)