NPIMap

Individual provider Active NPI

Victor Vance Carlock, NP

  • Nurse Practitioner
  • Leesville, LA
National Provider Identifier
1396948402
Registry record updated May 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP05193 Issued in LA
Practice address
1100 Nolan Trace
Leesville, LA 71446
Phone
(337) 238-5180
Fax
(318) 759-0828
NPI assigned
Jun 6, 2007
Last updated
May 20, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AP05193 LA Primary
Family Nurse Practitioner 363LF0000X AP05193 LA
Primary Care Nurse Practitioner 363LP2300X AP05193 LA

Addresses

Primary practice location

1100 Nolan Trace
Leesville, LA 71446

Mailing address

1100 Nolan Trace
Leesville, LA 71446
Phone (337) 238-5180

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110829000086 LA Practitioner - Nurse Practitioner 9335237478 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2007
Medicare assignment
May accept Medicare assignment
Group practices
Carlock Enterprises LLCGroup PAC ID 3476707514, 5 clinicians
Physical Therapy Services of West Louisiana IncGroup PAC ID 0446388763, 92 clinicians

Practice addresses (Care Compare)

1100 Nolan Trce
Leesville, LA 71446-3838
Phone (337) 238-5180

301 W Fertitta Blvd
Leesville, LA 71446-4665
Phone (337) 238-9931

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP05193LAMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Carlock Enterprises LLC CurrentSince Jun 1, 2012 Accepting new patients
Carlock Enterprises LLC Nurse Practitioner CurrentSince Jan 2, 2013 Accepting new patients
Deer Creek Imaging Center Past Accepting new patients

Locations

1100 Nolan Trce
Leesville, LA 71446
Phone (337) 238-5180

2778 Highway 121
Otis, LA 71466
Phone (318) 793-5020

2778 Highway 121
Ste A
Otis, LA 71466
Phone (318) 793-5020

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Carlock ClinicLeesville, LA, CCN 193928 Rural health clinic 5% Or Greater Direct Ownership Interest (50%)
Limited Partnership Interest (50%)
Operational/Managerial Control (100%)		 Jun 1, 2012
Jun 1, 2012
Jun 1, 2012
Carlock Family Medical ClinicOtis, LA, CCN 193955 Rural health clinic 5% Or Greater Direct Ownership Interest (50%)
Limited Partnership Interest (50%)		 Jun 1, 2012
Jun 1, 2012

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Carlock Enterprises LLC
    • Primary Care Clinic/Center
    • Otis, LA
    • NPI 1437506474

    5% Or Greater Direct Ownership Interest, Limited Partnership Interest

    CMS ownership
  • Carlock Enterprises LLC

    dba Carlock Family Medical Clinic

    • Rural Health Clinic/Center
    • Leesville, LA
    • NPI 1649524257

    5% Or Greater Direct Ownership Interest, Limited Partnership Interest, Operational/Managerial Control

    CMS ownership

Organizations & group practices 4

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.

Hospital & facility affiliations 26

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1181088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747699200000",
    "number": "1396948402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 NOLAN TRACE",
            "city": "LEESVILLE",
            "state": "LA",
            "postal_code": "71446",
            "telephone_number": "337-238-5180",
            "fax_number": "337-238-4840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 NOLAN TRACE",
            "city": "LEESVILLE",
            "state": "LA",
            "postal_code": "71446",
            "telephone_number": "337-238-5180",
            "fax_number": "318-759-0828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLOCK",
        "first_name": "VICTOR",
        "middle_name": "VANCE",
        "name_prefix": "Mr.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-06",
        "last_updated": "2025-05-20",
        "certification_date": "2025-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "LA",
            "license": "AP05193",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "AP05193",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "LA",
            "license": "AP05193",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Leesville, LA

Sources for this page

Verify at the official NPI Registry.