Healthcare Provider Details

I. General information

NPI: 1649524257
Provider Name (Legal Business Name): CARLOCK ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2012
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 NOLAN TRACE
LEESVILLE LA
71446
US

IV. Provider business mailing address

1100 NOLAN TRACE
LEESVILLE LA
71446
US

V. Phone/Fax

Practice location:
  • Phone: 337-238-5180
  • Fax: 318-759-0828
Mailing address:
  • Phone: 337-238-5180
  • Fax: 337-238-4840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateLA

VIII. Authorized Official

Name: MR. VICTOR VANCE CARLOCK
Title or Position: PROVIDER / OWNER
Credential: NP
Phone: 337-238-5180