Provider Demographics
NPI:1538164991
Name:NETHERLAND, CAROL ADAMS (CFNP)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ADAMS
Last Name:NETHERLAND
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PECAN PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3361
Mailing Address - Country:US
Mailing Address - Phone:318-445-6221
Mailing Address - Fax:318-445-5399
Practice Address - Street 1:201 PECAN PARK AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3361
Practice Address - Country:US
Practice Address - Phone:318-445-6221
Practice Address - Fax:318-445-5399
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN 030430/AP03476363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1557188Medicaid
LA1557188Medicaid
LAS84489Medicare UPIN