Healthcare Provider Details

I. General information

NPI: 1104254085
Provider Name (Legal Business Name): KARRA THOMAS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2013
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11990 JACKSON ST
CLINTON LA
70722-3210
US

IV. Provider business mailing address

2013 CENTRAL RD SUITE B
BATON ROUGE LA
70807-3942
US

V. Phone/Fax

Practice location:
  • Phone: 225-683-5292
  • Fax: 225-683-1310
Mailing address:
  • Phone: 225-774-1120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP07478
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: