Provider Demographics
NPI:1073010591
Name:CARTER, TIFFANY LANE (LPN)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LANE
Last Name:CARTER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 MAGNOLIA KNEE DR
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-6280
Mailing Address - Country:US
Mailing Address - Phone:337-351-1494
Mailing Address - Fax:
Practice Address - Street 1:106 HEYMANN BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2322
Practice Address - Country:US
Practice Address - Phone:337-504-4279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional