Andre' Jacob Carpenter, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA200495 Issued in LA

Practice address

2751 Albert L Bicknell Dr
4TH Floor
Shreveport, LA 71103-3920

Phone

(318) 212-4275

Fax

(318) 212-4555

NPI assigned

Nov 15, 2011

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: acarpenter@direct.wkhs.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southwest Medical Center Multi Specialty Group LLC

  • Family Medicine Physician
  • Lafayette, LA
  • NPI 1649456617
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1321315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624233600000",
    "number": "1255618591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2751 ALBERT L BICKNELL DR",
            "address_2": "4TH FLOOR",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033920",
            "telephone_number": "318-212-4275",
            "fax_number": "318-212-4555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2751 ALBERT L BICKNELL DR",
            "address_2": "4TH FLOOR",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033920",
            "telephone_number": "318-212-4275",
            "fax_number": "318-212-4555"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2751 Albert L Bicknell Dr Ste 2B",
            "address_purpose": "LOCATION",
            "city": "Shreveport",
            "state": "LA",
            "postal_code": "711033939",
            "country_code": "US",
            "telephone_number": "318-212-8350",
            "fax_number": "318-212-8356",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARPENTER",
        "first_name": "ANDRE'",
        "middle_name": "JACOB",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-11-15",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "LA",
            "license": "PA200495",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2173561",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.mettles.com/",
            "affiliation": "N",
            "endpointDescription": "2.16.840.1.113883.3.6037.1",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "10320 Little Patuxent Pkwy Ste 233-02",
            "city": "Columbia",
            "state": "MD",
            "country_code": "US",
            "postal_code": "210443313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lane S Carlisle, NP
• Wesley D. Carlisle, MD, DMD
• Harry Carmack
• Carmichael's Cashway Pharmacy, Inc. (Carmichael's North)
• John B Carmody
• Ernest Carpenter III, LOTR
• Kasey Jo Carpenter, LOTR
• Linda Russell Carpenter, RN
• Lindsay Kate Carpenter, LOTR
• Phillip D Carpenter, OT

• Physician Assistant in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Physician Assistant in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.