MEDICARE: TIFFANY CARR RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	242728	LA

General Provider Information

NPI Number	:	1386232775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY CARR RN

Provider Business Mailing Address
First Line	:	9030 NEWCASTLE DR
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71129-5122
Country	:	US
Telephone Number	:	318-780-2089
Fax Number	:

Provider Business Practice Location Address
First Line	:	9030 NEWCASTLE DR
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71129-5122
Country	:	US
Telephone Number	:	318-616-1013
Fax Number	:	318-225-4965

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2021
Last Update Date	:	05/11/2026

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