Provider Demographics
NPI:1417619701
Name:CARTER, ANDREA YOSHIKO (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:YOSHIKO
Last Name:CARTER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 BROADWAY BLVD STE 232
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-2591
Mailing Address - Country:US
Mailing Address - Phone:469-573-5539
Mailing Address - Fax:
Practice Address - Street 1:3960 BROADWAY BLVD STE 232
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-2591
Practice Address - Country:US
Practice Address - Phone:469-573-5539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1056750363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health