Provider Demographics
NPI:1083994347
Name:RIDEAUX, CAROLYN (NP)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:
Last Name:RIDEAUX
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:CAROLYN
Other - Middle Name:RIDEAUX
Other - Last Name:HORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:R N
Mailing Address - Street 1:2837 ERNEST ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8785
Mailing Address - Country:US
Mailing Address - Phone:337-480-8990
Mailing Address - Fax:337-439-1133
Practice Address - Street 1:2837 ERNEST ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8785
Practice Address - Country:US
Practice Address - Phone:337-480-8990
Practice Address - Fax:337-439-1133
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN044627-AP06618363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health