Provider Demographics
NPI:1043563638
Name:CARLSON, JESSICA T (NP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:T
Last Name:CARLSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19343 SUNSHINE AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-8834
Mailing Address - Country:US
Mailing Address - Phone:985-892-5125
Mailing Address - Fax:985-892-5128
Practice Address - Street 1:19343 SUNSHINE AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8834
Practice Address - Country:US
Practice Address - Phone:985-892-5125
Practice Address - Fax:985-892-5128
Is Sole Proprietor?:No
Enumeration Date:2012-10-19
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06955363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health