Provider Demographics
NPI:1275206799
Name:CARTER, KISHUNA (PHELBOTOMIST)
Entity Type:Individual
Prefix:
First Name:KISHUNA
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:PHELBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 SEAMON AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21225-1135
Mailing Address - Country:US
Mailing Address - Phone:443-802-0309
Mailing Address - Fax:
Practice Address - Street 1:9 CHURCH ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225-3501
Practice Address - Country:US
Practice Address - Phone:443-802-0309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21-6126246RP1900X
MD246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy