Provider Demographics
NPI:1184240293
Name:MOTON, CARRIE JO (FNP-BC)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:JO
Last Name:MOTON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71052-3105
Mailing Address - Country:US
Mailing Address - Phone:318-301-6627
Mailing Address - Fax:318-872-7048
Practice Address - Street 1:513 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:LA
Practice Address - Zip Code:71052-3105
Practice Address - Country:US
Practice Address - Phone:318-301-6627
Practice Address - Fax:318-872-7048
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA213962363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily