Provider Demographics
NPI:1164424107
Name:CARTER, KEVIN PATRICK (AUD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:PATRICK
Last Name:CARTER
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 2ND ST
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-2453
Mailing Address - Country:US
Mailing Address - Phone:276-964-6010
Mailing Address - Fax:276-964-2929
Practice Address - Street 1:1326 2ND ST
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-2453
Practice Address - Country:US
Practice Address - Phone:276-964-6010
Practice Address - Fax:276-964-2929
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201000685231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T33449Medicare UPIN