Provider Demographics
NPI:1275318933
Name:CARLTON, MISTI KATHERINE (PMHNP)
Entity Type:Individual
Prefix:
First Name:MISTI
Middle Name:KATHERINE
Last Name:CARLTON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 FERNBANK AVE
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-4034
Mailing Address - Country:US
Mailing Address - Phone:347-601-6354
Mailing Address - Fax:
Practice Address - Street 1:29 FERNBANK AVE
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-4034
Practice Address - Country:US
Practice Address - Phone:347-601-6354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF404979363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health