Provider Demographics
NPI:1205859725
Name:CARPENTER, DEBRA ANN (NP,DC)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:ANN
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:NP,DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 S JOE MARTINEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-2741
Mailing Address - Country:US
Mailing Address - Phone:719-647-1043
Mailing Address - Fax:719-647-9287
Practice Address - Street 1:267 S JOE MARTINEZ BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-2741
Practice Address - Country:US
Practice Address - Phone:719-647-1043
Practice Address - Fax:719-647-9287
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0990625-NP363LF0000X
CO3535111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO431739245OtherTAX IDENTIFICATION
COC44543Medicare ID - Type Unspecified