Provider Demographics
NPI:1750958153
Name:THOMPSON, CARLA DANIELLE (CNA)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:DANIELLE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10707 INDUSTRIPLEX BLVD APT 1
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3923
Mailing Address - Country:US
Mailing Address - Phone:832-207-3990
Mailing Address - Fax:
Practice Address - Street 1:8313 PICARDY AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3689
Practice Address - Country:US
Practice Address - Phone:225-906-4097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-06
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1387293104A0625X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness