Provider Demographics
NPI:1164740593
Name:CARTER, JONATHON COLLIN (BS, CM2)
Entity Type:Individual
Prefix:
First Name:JONATHON
Middle Name:COLLIN
Last Name:CARTER
Suffix:
Gender:M
Credentials:BS, CM2
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 332
Mailing Address - Street 2:
Mailing Address - City:WATTS
Mailing Address - State:OK
Mailing Address - Zip Code:74964-0332
Mailing Address - Country:US
Mailing Address - Phone:918-422-4888
Mailing Address - Fax:
Practice Address - Street 1:202 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:WATTS
Practice Address - State:OK
Practice Address - Zip Code:74964-0332
Practice Address - Country:US
Practice Address - Phone:918-422-4888
Practice Address - Fax:918-422-5779
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator