Provider Demographics
NPI:1780220160
Name:CARTER, KRISTEN (NP-C)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4579 HICKORY HILL RD
Mailing Address - Street 2:
Mailing Address - City:KENTS STORE
Mailing Address - State:VA
Mailing Address - Zip Code:23084-2138
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2615 ANDERSON HWY
Practice Address - Street 2:
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-7400
Practice Address - Country:US
Practice Address - Phone:804-794-1555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177907207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine