1164875621 NPI number — MRS. CARMEN NICOLE ROLLINS FNP

Table of content: MRS. CARMEN NICOLE ROLLINS FNP (NPI 1164875621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164875621 NPI number — MRS. CARMEN NICOLE ROLLINS FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROLLINS
Provider First Name:
CARMEN
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BLOOD
Provider Other First Name:
CARMEN
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164875621
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 542
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PINE PRAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70576-0542
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-599-2800
Provider Business Mailing Address Fax Number:
337-599-2210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1121 WALNUT ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINE PRAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70576-0542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-599-2800
Provider Business Practice Location Address Fax Number:
337-599-2210
Provider Enumeration Date:
07/20/2016

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:  AP08823 , 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)





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