Provider Demographics
NPI:1710180591
Name:CARTER, STACIE B (MSN, CNM)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:B
Last Name:CARTER
Suffix:
Gender:F
Credentials:MSN, CNM
Other - Prefix:
Other - First Name:STACIE
Other - Middle Name:CARTER
Other - Last Name:GIBBINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1580 W ANTELOPE DR
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1160
Mailing Address - Country:US
Mailing Address - Phone:801-776-0880
Mailing Address - Fax:801-773-7399
Practice Address - Street 1:1580 W ANTELOPE DR
Practice Address - Street 2:SUITE 290
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1160
Practice Address - Country:US
Practice Address - Phone:801-776-0880
Practice Address - Fax:801-773-7399
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1710180591Medicaid