Provider Demographics
NPI:1881394427
Name:CARTER, CELESTE ALEXANDRA (FNP-C)
Entity type:Individual
Prefix:MISS
First Name:CELESTE
Middle Name:ALEXANDRA
Last Name:CARTER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:CELESTE
Other - Middle Name:ALEXANDRA
Other - Last Name:CLIFTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:9111 SUSAN DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3136
Mailing Address - Country:US
Mailing Address - Phone:318-687-5500
Mailing Address - Fax:
Practice Address - Street 1:9111 SUSAN DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3136
Practice Address - Country:US
Practice Address - Phone:318-687-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-02
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAF07220065207Q00000X
LA229633363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty