Provider Demographics
NPI:1770234338
Name:CARTER, EMILY FOREMAN (PA-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:FOREMAN
Last Name:CARTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:BROOKE
Other - Last Name:FOREMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:283 W RACE ST
Mailing Address - Street 2:
Mailing Address - City:ROLLING FORK
Mailing Address - State:MS
Mailing Address - Zip Code:39159-2621
Mailing Address - Country:US
Mailing Address - Phone:662-873-0477
Mailing Address - Fax:662-655-1236
Practice Address - Street 1:283 W RACE ST
Practice Address - Street 2:
Practice Address - City:ROLLING FORK
Practice Address - State:MS
Practice Address - Zip Code:39159-2621
Practice Address - Country:US
Practice Address - Phone:662-873-0477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-15
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant