Provider Demographics
NPI:1619213899
Name:CARPENTER, CHRISTINA D (ACNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:CHRISTINA
Middle Name:D
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:MRS
Other - First Name:CHRISTINA
Other - Middle Name:DODSON
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 RUE DE LA VIE ST STE 513
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-5129
Mailing Address - Country:US
Mailing Address - Phone:225-924-8550
Mailing Address - Fax:225-924-8647
Practice Address - Street 1:500 RUE DE LA VIE ST STE 513
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-5129
Practice Address - Country:US
Practice Address - Phone:225-924-8550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-17
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17182363LA2100X
LARN123094AP07551363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2351290Medicaid
LA2351290Medicaid