Provider Demographics
NPI:1699719070
Name:RAYMOND, CAROL A (FNP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 GAUSE BLVD E
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-4141
Mailing Address - Country:US
Mailing Address - Phone:985-641-7283
Mailing Address - Fax:985-641-7207
Practice Address - Street 1:2360 GAUSE BLVD E
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4141
Practice Address - Country:US
Practice Address - Phone:985-641-7283
Practice Address - Fax:985-641-7207
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPRN33774363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09256085Medicaid
LA1559181Medicaid
LAQ68996Medicare UPIN
LAP00320047Medicare PIN
LA1559181Medicaid