Provider Demographics
NPI:1275015760
Name:CARTER, REGINA
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MCGRADY
Mailing Address - Street 1:7521 BRAYTON DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-2667
Mailing Address - Country:US
Mailing Address - Phone:907-929-5826
Mailing Address - Fax:907-929-5862
Practice Address - Street 1:7521 BRAYTON DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-2667
Practice Address - Country:US
Practice Address - Phone:907-929-5826
Practice Address - Fax:907-929-5862
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK00000OtherNO MEDICAID ID YET