Healthcare Provider Details

I. General information

NPI: 1033560271
Provider Name (Legal Business Name): ADAM CARNEY NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7384 JOHN LEBLANC BLVD
SORRENTO LA
70778-3231
US

IV. Provider business mailing address

7384 JOHN LEBLANC BLVD
SORRENTO LA
70778-3231
US

V. Phone/Fax

Practice location:
  • Phone: 225-310-2600
  • Fax: 225-612-6828
Mailing address:
  • Phone: 225-310-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP08852
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: