Provider Demographics
NPI:1568434561
Name:CARTER, MELINDA ANNE (PA)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:ANNE
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 1:6471 GLEN RIVER CIR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-3051
Mailing Address - Country:US
Mailing Address - Phone:702-301-5964
Mailing Address - Fax:
Practice Address - Street 1:6471 GLEN RIVER CIR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-3051
Practice Address - Country:US
Practice Address - Phone:702-301-5964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA 841363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100503580Medicaid
NV100503272Medicaid
NV1568434561OtherSMA MEDICAID
NVV114103OtherSMA MEDICARE
NV100503580Medicaid
NVV114103OtherSMA MEDICARE