Provider Demographics
NPI:1780681486
Name:CARTER, JOHN EVERETT (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:EVERETT
Last Name:CARTER
Suffix:
Gender:M
Credentials:PA-C
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 2459
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-7459
Mailing Address - Country:US
Mailing Address - Phone:817-326-2727
Mailing Address - Fax:817-326-5737
Practice Address - Street 1:2200 JAMES RD
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-8207
Practice Address - Country:US
Practice Address - Phone:817-326-2727
Practice Address - Fax:817-326-5737
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01396363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical