Provider Demographics
NPI:1407202047
Name:CARTER, JILL E
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:E
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:E
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LVN
Mailing Address - Street 1:6214 RHAPSODY LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75241-2622
Mailing Address - Country:US
Mailing Address - Phone:214-725-9233
Mailing Address - Fax:
Practice Address - Street 1:4099 MCEWEN RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-5030
Practice Address - Country:US
Practice Address - Phone:214-754-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117003164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse