Provider Demographics
NPI:1093141004
Name:CARTER, MOLLIE (NP-C)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7033 SAINT ANDREWS RD STE 205
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-1181
Practice Address - Country:US
Practice Address - Phone:803-749-1155
Practice Address - Fax:803-749-1786
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006460363L00000X
SC19117363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1093141004Medicaid
NCNCF152EMedicare PIN
NCNCF152CMedicare PIN
NCNCF152DMedicare PIN
NCNCF152AMedicare PIN
NCNCF152BMedicare PIN
NC1093141004Medicaid