Provider Demographics
NPI:1073579314
Name:TWYMAN, CAROL S (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:S
Last Name:TWYMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 COTTON LN
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055-8090
Mailing Address - Country:US
Mailing Address - Phone:318-377-1653
Mailing Address - Fax:
Practice Address - Street 1:319 COTTON LN
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-8090
Practice Address - Country:US
Practice Address - Phone:318-268-0703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018536207P00000X, 207R00000X
MO2016007206207P00000X
TXT2515207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1355712Medicaid
LA52504F600Medicare ID - Type Unspecified
LA1355712Medicaid