Provider Demographics
NPI:1457357469
Name:CARLETON, CHARLES RICHARD (MSN, FNP-C)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:RICHARD
Last Name:CARLETON
Suffix:
Gender:M
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9075 SUMMER TREE CIR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:LA
Mailing Address - Zip Code:71033-3051
Mailing Address - Country:US
Mailing Address - Phone:318-938-6743
Mailing Address - Fax:
Practice Address - Street 1:510 STONER AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4123
Practice Address - Country:US
Practice Address - Phone:318-221-8411
Practice Address - Fax:318-429-5710
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-099327363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA-099327OtherIOWA BD OF NURSING