Provider Demographics
NPI:1356687651
Name:CARTER, KRISTINE (RN, MS, PNP-BC)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:RN, MS, PNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:991 14TH ST BLDG H
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-3230
Mailing Address - Country:US
Mailing Address - Phone:510-874-7272
Mailing Address - Fax:510-834-3586
Practice Address - Street 1:991 14TH ST BLDG H
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-3230
Practice Address - Country:US
Practice Address - Phone:510-874-7272
Practice Address - Fax:510-834-3586
Is Sole Proprietor?:No
Enumeration Date:2012-12-14
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22182363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics