Provider Demographics
NPI:1528398229
Name:CARTER CLINIC LLC
Entity Type:Organization
Organization Name:CARTER CLINIC LLC
Other - Org Name:CARTER CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC CWCN
Authorized Official - Phone:731-394-3499
Mailing Address - Street 1:546 LAMBUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-5156
Mailing Address - Country:US
Mailing Address - Phone:731-349-3499
Mailing Address - Fax:731-423-2773
Practice Address - Street 1:546 LAMBUTH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-5156
Practice Address - Country:US
Practice Address - Phone:731-394-3499
Practice Address - Fax:731-423-2773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN6510363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty