Provider Demographics
NPI:1922670389
Name:CARTER, LEXIS DIANA (PA)
Entity Type:Individual
Prefix:
First Name:LEXIS
Middle Name:DIANA
Last Name:CARTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 N ST FRANKLIN RD #303
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY TN
Mailing Address - State:TN
Mailing Address - Zip Code:37604
Mailing Address - Country:US
Mailing Address - Phone:423-926-8181
Mailing Address - Fax:423-926-8652
Practice Address - Street 1:310 N ST FRANKLIN RD #303
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-3652
Practice Address - Country:US
Practice Address - Phone:423-926-8181
Practice Address - Fax:423-926-8652
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4598363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant