Provider Demographics
NPI: | 1477658987 |
---|---|
Name: | CARTER, JENNIFER H (PA) |
Entity Type: | Individual |
Prefix: | |
First Name: | JENNIFER |
Middle Name: | H |
Last Name: | CARTER |
Suffix: | |
Gender: | F |
Credentials: | PA |
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 1259 |
Mailing Address - Street 2: | SENTINEL HEALTH PARTNERS PA BUSINESS OFFICE |
Mailing Address - City: | CAMDEN |
Mailing Address - State: | SC |
Mailing Address - Zip Code: | 29021-1259 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 803-713-8350 |
Mailing Address - Fax: | 803-713-8433 |
Practice Address - Street 1: | 710 DEWITT DR |
Practice Address - Street 2: | |
Practice Address - City: | LUGOFF |
Practice Address - State: | SC |
Practice Address - Zip Code: | 29078-9069 |
Practice Address - Country: | US |
Practice Address - Phone: | 803-438-7566 |
Practice Address - Fax: | 803-438-4371 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-09-13 |
Last Update Date: | 2013-08-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
SC | 1128 | 363AM0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
SC | P00371643 | Other | RAILROAD MEDICARE PIN |
SC | 0477PA | Medicaid | |
192417 | Other | MEDCOST PIN | |
SC | 0477PA | Medicaid | |
SC | AA15495360 | Medicare PIN |