Provider Demographics
NPI:1609643402
Name:HART-CARPENTER, MALIK
Entity Type:Individual
Prefix:
First Name:MALIK
Middle Name:
Last Name:HART-CARPENTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 BRITTMOORE RD APT 3401
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-5076
Mailing Address - Country:US
Mailing Address - Phone:346-730-0207
Mailing Address - Fax:
Practice Address - Street 1:1095 BRITTMOORE RD APT 3401
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-5076
Practice Address - Country:US
Practice Address - Phone:346-730-0207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide