Provider Demographics
NPI:1346801412
Name:CARTER, JESSICA NICOLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:CARTER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 30TH AVE N APT 304
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1583
Mailing Address - Country:US
Mailing Address - Phone:270-779-9449
Mailing Address - Fax:
Practice Address - Street 1:109 GALLATIN PIKE N
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-3701
Practice Address - Country:US
Practice Address - Phone:615-865-6077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY018523183500000X
TN0000043183183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0000043183OtherTENNESSEE BOARD OF PHARMACY
KY081523OtherKENTUCKY BOARD OF PHARMACY