Provider Demographics
NPI:1558245605
Name:HENRY-CARMOUCHE, ANGELA MICHELLE (CNP)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MICHELLE
Last Name:HENRY-CARMOUCHE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 BAMBOO ST
Mailing Address - Street 2:
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-6240
Mailing Address - Country:US
Mailing Address - Phone:337-849-3974
Mailing Address - Fax:337-849-3974
Practice Address - Street 1:1012 BAMBOO ST
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-6240
Practice Address - Country:US
Practice Address - Phone:337-849-3974
Practice Address - Fax:337-849-3974
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-02
Last Update Date:2025-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA242448363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily