1144691320 NPI number — MRS. REGENIA D CARTER APRN

Table of content: MRS. REGENIA D CARTER APRN (NPI 1144691320)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144691320 NPI number — MRS. REGENIA D CARTER APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARTER
Provider First Name:
REGENIA
Provider Middle Name:
D
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144691320
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7495
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-388-1250
Provider Business Mailing Address Fax Number:
318-388-0948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2913 DESIARD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-651-9914
Provider Business Practice Location Address Fax Number:
318-410-0688
Provider Enumeration Date:
10/13/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  A004550 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 224922 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A004550 . This is a "LICENSE NUMBER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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