Provider Demographics
NPI:1750678819
Name:CARPENTER, DEAUN (APRN)
Entity Type:Individual
Prefix:
First Name:DEAUN
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 154
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:NE
Mailing Address - Zip Code:69033-0154
Mailing Address - Country:US
Mailing Address - Phone:308-883-0601
Mailing Address - Fax:308-882-5993
Practice Address - Street 1:623 BROADWAY
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:NE
Practice Address - Zip Code:69033-3136
Practice Address - Country:US
Practice Address - Phone:308-883-0601
Practice Address - Fax:308-882-5993
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111451363LF0000X
COANP 100065363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily