Provider Demographics
NPI:1083806277
Name:CARTER, ANGELA GAYLE (APRN, BC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:GAYLE
Last Name:CARTER
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:WV
Mailing Address - Zip Code:25043-7046
Mailing Address - Country:US
Mailing Address - Phone:304-587-7301
Mailing Address - Fax:304-587-2464
Practice Address - Street 1:122 CENTER ST
Practice Address - Street 2:
Practice Address - City:CLAY
Practice Address - State:WV
Practice Address - Zip Code:25043-7046
Practice Address - Country:US
Practice Address - Phone:304-587-7301
Practice Address - Fax:304-587-2464
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV57397363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810010919Medicaid
WV2032974Medicare PIN
WV2029344Medicare PIN
WV2032978Medicare PIN
WVWV1980BMedicare PIN
WVWV1980FMedicare PIN
WVWV1980IMedicare PIN
WV2032972Medicare PIN
WVWV1980HMedicare PIN
WV2029345Medicare PIN
WVWV1980AMedicare PIN
WVWV1980CMedicare PIN
WVWV1980DMedicare PIN
WV3810010919Medicaid
WV2032971Medicare PIN
WV2032976Medicare PIN
WVWV1980EMedicare PIN
WVWV1980GMedicare PIN
WV2032975Medicare PIN
WV2029341Medicare PIN
WV2029343Medicare PIN
WV2032973Medicare PIN
WV2029342Medicare PIN