Healthcare Provider Details

I. General information

NPI: 1386232775
Provider Name (Legal Business Name): TIFFANY CARR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2021
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E STONER AVE
SHREVEPORT LA
71101-4243
US

IV. Provider business mailing address

9030 NEWCASTLE DR
SHREVEPORT LA
71129-5122
US

V. Phone/Fax

Practice location:
  • Phone: 318-221-8411
  • Fax:
Mailing address:
  • Phone: 318-780-2089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN154693
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number242728
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: