Provider Demographics
NPI:1356815286
Name:CARTER, TONYA MARIE
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:MARIE
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CUMBERLAND AVE APT C8
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TN
Mailing Address - Zip Code:37347-3164
Mailing Address - Country:US
Mailing Address - Phone:423-497-6531
Mailing Address - Fax:
Practice Address - Street 1:500 CUMBERLAND AVE APT C8
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TN
Practice Address - Zip Code:37347-3164
Practice Address - Country:US
Practice Address - Phone:423-497-6531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty