Provider Demographics
NPI:1558013540
Name:CARPENTER, MEKDES ERICKA
Entity Type:Individual
Prefix:
First Name:MEKDES
Middle Name:ERICKA
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 ARBOR GATE CIR APT H
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-6021
Mailing Address - Country:US
Mailing Address - Phone:843-597-2002
Mailing Address - Fax:
Practice Address - Street 1:195 ARBOR GATE CIR APT H
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-6021
Practice Address - Country:US
Practice Address - Phone:843-597-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker