Provider Demographics
NPI:1023321601
Name:CARPENTER, CAROLINE DIXON (DNP)
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:DIXON
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1962 JULIA ST
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-5527
Mailing Address - Country:US
Mailing Address - Phone:318-728-8833
Mailing Address - Fax:318-728-6183
Practice Address - Street 1:448 NEWTON ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:LA
Practice Address - Zip Code:71366-4330
Practice Address - Country:US
Practice Address - Phone:318-766-8506
Practice Address - Fax:318-728-6183
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05975363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05830071Medicaid
LA2117696Medicaid
LA390797YH3VMedicare PIN