Provider Demographics
NPI:1114445053
Name:CARTER, MEGAN KRISTINE (PA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:KRISTINE
Last Name:CARTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:25590 PROSPECT AVE APT 4B
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3142
Mailing Address - Country:US
Mailing Address - Phone:806-683-4734
Mailing Address - Fax:
Practice Address - Street 1:25590 PROSPECT AVE APT 4B
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3142
Practice Address - Country:US
Practice Address - Phone:806-683-4734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant