Healthcare Provider Details

I. General information

NPI: 1023321601
Provider Name (Legal Business Name): CAROLINE DIXON CARPENTER DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 NEWTON ST
SAINT JOSEPH LA
71366-4330
US

IV. Provider business mailing address

1962 JULIA ST
RAYVILLE LA
71269-5527
US

V. Phone/Fax

Practice location:
  • Phone: 318-766-8506
  • Fax: 318-728-6183
Mailing address:
  • Phone: 318-728-8833
  • Fax: 318-728-6183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP05975
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: