Provider Demographics
NPI:1467459990
Name:CARTER, VICKI G (APRN, MSN, CDE)
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:G
Last Name:CARTER
Suffix:
Gender:F
Credentials:APRN, MSN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3889
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-3889
Mailing Address - Country:US
Mailing Address - Phone:423-794-2457
Mailing Address - Fax:423-283-9480
Practice Address - Street 1:150 E BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-2329
Practice Address - Country:US
Practice Address - Phone:423-237-6900
Practice Address - Fax:423-532-8710
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN 5671363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3903368Medicaid
TN3903364Medicaid
TNS80969Medicare UPIN
TN3903368Medicaid
TN3903368Medicaid