Provider Demographics
NPI:1497417299
Name:HENSON, CARLY HAWS (FNP)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:HAWS
Last Name:HENSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 HIGHWAY 190 E
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-8510
Mailing Address - Country:US
Mailing Address - Phone:985-543-6800
Mailing Address - Fax:985-543-6801
Practice Address - Street 1:2511 HIGHWAY 190 E
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-8510
Practice Address - Country:US
Practice Address - Phone:985-543-6800
Practice Address - Fax:985-543-6801
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA220802363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily