Provider Demographics
NPI:1932310687
Name:CARPER, SHEYENNE W (MD)
Entity Type:Individual
Prefix:
First Name:SHEYENNE
Middle Name:W
Last Name:CARPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHEYENNE
Other - Middle Name:
Other - Last Name:WILBORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:845 OLIVE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2141
Mailing Address - Country:US
Mailing Address - Phone:318-226-4892
Mailing Address - Fax:318-227-4927
Practice Address - Street 1:845 OLIVE ST
Practice Address - Street 2:SUITE A
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2141
Practice Address - Country:US
Practice Address - Phone:318-226-4892
Practice Address - Fax:318-227-4927
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200925208000000X
LAMD.200925208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA21472Medicaid
AR180367001Medicaid
TX209258701Medicaid
LA1214728Medicaid
AR180367001Medicaid
LA4N285Medicare PIN