Provider Demographics
NPI:1033154513
Name:CARTER, JANICE (FNP)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2086 ADDISON AVE E
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5306
Mailing Address - Country:US
Mailing Address - Phone:208-733-9697
Mailing Address - Fax:208-733-3197
Practice Address - Street 1:2086 ADDISON AVE E
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5306
Practice Address - Country:US
Practice Address - Phone:208-733-9697
Practice Address - Fax:208-733-3197
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP712363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807194400Medicaid
IDQ49970Medicare UPIN
ID13456762Medicare PIN