Healthcare Provider Details

I. General information

NPI: 1699484634
Provider Name (Legal Business Name): CARSON LUKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HENRY CLAY AVE
NEW ORLEANS LA
70118-5720
US

IV. Provider business mailing address

66 COUNTY ROAD 409
OXFORD MS
38655-9226
US

V. Phone/Fax

Practice location:
  • Phone: 601-405-4170
  • Fax:
Mailing address:
  • Phone: 601-405-4170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number906925
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number916621
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: