Provider Demographics
NPI:1740223387
Name:CARTER, SANDRA (NP)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 AVON AVE
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-4709
Mailing Address - Country:US
Mailing Address - Phone:318-243-3793
Mailing Address - Fax:318-247-6018
Practice Address - Street 1:2913 BETIN AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201
Practice Address - Country:US
Practice Address - Phone:318-388-1250
Practice Address - Fax:318-247-6018
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04142207P00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1141721Medicaid
LAP83156Medicare UPIN