Provider Demographics
NPI:1629329537
Name:CARPENTER, STEPHANIE MARGARET (PMHNP-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARGARET
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:PMHNP-C
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:MARGARET
Other - Last Name:RENNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2315 8TH ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-7303
Mailing Address - Country:US
Mailing Address - Phone:208-746-1383
Mailing Address - Fax:208-746-6348
Practice Address - Street 1:2315 8TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-7303
Practice Address - Country:US
Practice Address - Phone:208-746-1383
Practice Address - Fax:208-746-6348
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1229A363LP0808X, 363LF0000X
WAAP60511737363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1629329537OtherUNITED HEALTHCARE
ID1629329537OtherIPN
ID1629329537OtherAETNA
1629329537OtherFCHN
ID1629329537OtherBLUE CROSS OF ID
WA1629329537OtherMOLINA HEALTHCARE OF WA
WA1629329537Medicaid
ID1629329537OtherREGENCE BLUE SHIELD OF ID
ID1629329537Medicaid
WA1629329537Medicaid
ID20005289Medicare PIN