Provider Demographics
NPI:1760461875
Name:CARLISLE, KELLY MORGAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:MORGAN
Last Name:CARLISLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:JEAN
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:ONE SAINT MARY PLACE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-0000
Mailing Address - Country:US
Mailing Address - Phone:318-681-6812
Mailing Address - Fax:318-684-7185
Practice Address - Street 1:ONE SAINT MARY PLACE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-0000
Practice Address - Country:US
Practice Address - Phone:318-681-6812
Practice Address - Fax:318-681-7185
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14004R207R00000X
LAMD.14004R207R00000X
WAMD60821843207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1183661Medicaid
LA4A348CQ62Medicare UPIN
H39418Medicare UPIN
LAH39418Medicare UPIN
LA4A348Medicare ID - Type Unspecified