Provider Demographics
NPI:1205313392
Name:SOLOMON, CARLY (AGACNP)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 HOUMA BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2924
Mailing Address - Country:US
Mailing Address - Phone:504-503-7000
Mailing Address - Fax:504-503-6730
Practice Address - Street 1:4315 HOUMA BLVD STE 500
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2942
Practice Address - Country:US
Practice Address - Phone:504-889-5250
Practice Address - Fax:504-503-5201
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP10128363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health