Provider Demographics
NPI:1578606299
Name:ALBIN-DAVENPORT, CAROLYN LOUISE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:LOUISE
Last Name:ALBIN-DAVENPORT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:LOUISE
Other - Last Name:ALBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2668
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-2668
Mailing Address - Country:US
Mailing Address - Phone:985-230-1332
Mailing Address - Fax:985-230-1334
Practice Address - Street 1:15790 PAUL VEGA MD DR
Practice Address - Street 2:FINANCE DEPARTMENT
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1434
Practice Address - Country:US
Practice Address - Phone:985-230-1682
Practice Address - Fax:985-230-1617
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN058607163W00000X
LAAP02871363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1531782Medicaid
LA1531782Medicaid
5A499Medicare ID - Type Unspecified