Provider Demographics
NPI:1598077323
Name:CARTER, VIRGINIA HOMZA
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:HOMZA
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WK PEDIATRIC HEALTH & WELLNESS
Mailing Address - Street 2:909 OLIVE STREET
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2103
Mailing Address - Country:US
Mailing Address - Phone:318-698-3291
Mailing Address - Fax:318-698-3293
Practice Address - Street 1:909 OLIVE ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104
Practice Address - Country:US
Practice Address - Phone:318-698-3291
Practice Address - Fax:318-698-3293
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-2322208000000X
LAMD.206164208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2340379Medicaid