Provider Demographics
NPI:1225055171
Name:CARTER, KACIE BETH (FNP)
Entity Type:Individual
Prefix:
First Name:KACIE
Middle Name:BETH
Last Name:CARTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KACIE
Other - Middle Name:BETH
Other - Last Name:TARTARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:2759 S HIGHWAY 14
Practice Address - Street 2:SUITE A
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-4926
Practice Address - Country:US
Practice Address - Phone:864-849-9701
Practice Address - Fax:864-849-9710
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRX1726363LF0000X
SC1726363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA01713365OtherMEDICARE PIN
SCNP2507Medicaid
SCP01548050OtherRAILROAD MEDICARE
SCAA01714746OtherMEDICARE PIN
SCAA01717652OtherMEDICARE PIN
SCAA01715640Medicare PIN
SCAA01714746Medicare PIN