Healthcare Provider Details

I. General information

NPI: 1083940845
Provider Name (Legal Business Name): CARLISA A WASHINGTON CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2009
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 PARKWAY DR STE A
NATCHITOCHES LA
71457-6276
US

IV. Provider business mailing address

1055 PARKWAY DR STE A
NATCHITOCHES LA
71457-6276
US

V. Phone/Fax

Practice location:
  • Phone: 318-352-6464
  • Fax: 318-352-2488
Mailing address:
  • Phone: 318-352-6464
  • Fax: 318-352-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number20091934
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: