Provider Demographics
NPI:1124180997
Name:CARLTON, JEFFREY S (RN CRNFA)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:CARLTON
Suffix:
Gender:M
Credentials:RN CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9261 WILDCAT ROAD
Mailing Address - Street 2:
Mailing Address - City:KELSEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95451-8813
Mailing Address - Country:US
Mailing Address - Phone:707-279-2109
Mailing Address - Fax:707-279-2109
Practice Address - Street 1:18TH AVE AND HWY 53
Practice Address - Street 2:ADVENTIST HEALTH REDBUD COMMUNITY HOSPITAL
Practice Address - City:CLEARLAKE
Practice Address - State:CA
Practice Address - Zip Code:95422
Practice Address - Country:US
Practice Address - Phone:707-995-5883
Practice Address - Fax:707-995-0223
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN250076163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ37844ZOtherBLUE SHIELD