Provider Demographics
NPI:1336137942
Name:CARTER, MICHAEL ALLEN (DNSC, APN)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALLEN
Last Name:CARTER
Suffix:
Gender:M
Credentials:DNSC, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 BELMONT ACRES CIR
Mailing Address - Street 2:
Mailing Address - City:TUMBLING SHOALS
Mailing Address - State:AR
Mailing Address - Zip Code:72581-9427
Mailing Address - Country:US
Mailing Address - Phone:501-362-0763
Mailing Address - Fax:501-362-7463
Practice Address - Street 1:369 BELMONT ACRES CIR
Practice Address - Street 2:
Practice Address - City:TUMBLING SHOALS
Practice Address - State:AR
Practice Address - Zip Code:72581-9427
Practice Address - Country:US
Practice Address - Phone:501-362-0763
Practice Address - Fax:501-362-7463
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01205363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARS58502Medicare UPIN