Provider Demographics
NPI:1396948402
Name:CARLOCK, VICTOR VANCE (NP)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:VANCE
Last Name:CARLOCK
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1100 NOLAN TRACE
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446
Mailing Address - Country:US
Mailing Address - Phone:337-238-5180
Mailing Address - Fax:337-238-4840
Practice Address - Street 1:1100 NOLAN TRACE
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446
Practice Address - Country:US
Practice Address - Phone:337-238-5180
Practice Address - Fax:318-759-0828
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05193363LP2300X, 363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily