Healthcare Provider Details

I. General information

NPI: 1356796221
Provider Name (Legal Business Name): YOYANDA CARROLL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 SMITH REED RD
LAFAYETTE LA
70507-2605
US

IV. Provider business mailing address

2319 NORTHSIDE DR
BOSSIER CITY LA
71111-3405
US

V. Phone/Fax

Practice location:
  • Phone: 888-988-9848
  • Fax: 866-625-8448
Mailing address:
  • Phone: 318-426-7255
  • Fax: 866-625-8448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: