Individual
MR. ANDRE' JACOB CARPENTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
2751 ALBERT L BICKNELL DR, 4TH FLOOR, SHREVEPORT, LA 71103-3920
(318) 212-4275
(318) 212-4555
Mailing address
2751 ALBERT L BICKNELL DR, 4TH FLOOR, SHREVEPORT, LA 71103-3920
(318) 212-4275
(318) 212-4555
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA200495
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2173561
—
LA
Enumeration date
11/15/2011
Last updated
06/21/2021
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