Provider Demographics
NPI:1568074565
Name:TYNES, CARLA CUNNINGHAM (RN)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:CUNNINGHAM
Last Name:TYNES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 ASHLEY RIDGE BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-7238
Mailing Address - Country:US
Mailing Address - Phone:318-820-8078
Mailing Address - Fax:
Practice Address - Street 1:460 ASHLEY RIDGE BLVD STE 500
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-7238
Practice Address - Country:US
Practice Address - Phone:318-820-8078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN037324163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical