Healthcare Provider Details

I. General information

NPI: 1437506474
Provider Name (Legal Business Name): CARLOCK ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2778 HWY 121 SUITE A
OTIS LA
71466-0000
US

IV. Provider business mailing address

2778 HWY 121 SUITE A
OTIS LA
71466-0000
US

V. Phone/Fax

Practice location:
  • Phone: 318-793-5020
  • Fax: 318-759-0828
Mailing address:
  • Phone: 318-793-5020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VICTOR CARLOCK
Title or Position: FNP/OWNER
Credential: FNP
Phone: 318-419-5188