| Doctor Name: | MRS. JENNIFER B CARLOCK |
| NPI Number: | 1164616553 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | AP05283 |
| Business Practice Address: | 1100 Nolan Trace Leesville, LA - 71446 |
| Business Phone Number: | 3372385180 |
| Business Fax Number: | 3372384840 |
| Mailing Address: | 1100 Nolan Trace, LEESVILLE |
| State: | LA |
| Postal Code: | 71446 |
| Phone Number: | 3372385180 |
| Fax Number: | 3372384840 |
| NPI Enumeration Date: | 08/29/2007 |
| NPI Last Update Date: | 10/02/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | AP05283 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | LA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |