Provider Demographics
NPI:1679252027
Name:YOUNGBLOOD, DARRELL TARRELL (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:DARRELL
Middle Name:TARRELL
Last Name:YOUNGBLOOD
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 MANHATTAN BLVD BLDG D
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-3583
Mailing Address - Country:US
Mailing Address - Phone:504-544-1061
Mailing Address - Fax:
Practice Address - Street 1:1901 MANHATTAN BLVD BLDG D
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-3583
Practice Address - Country:US
Practice Address - Phone:504-544-1061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14200300-4405363LP0808X
PASP030665363LP0808X
OR10027568363LP0808X
FLAPRN11027857363LP0808X
VT101.0137736TELE363LP0808X
NM83048363LP0808X
TX1143578363LP0808X
COAPN.0102818-C-NP363LP0808X
VA0024189159363LP0808X
NY406045363LP0808X
WAAP61661385363LP0808X
AZ321232363LP0808X
LA206593363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty