Provider Demographics
NPI:1952312241
Name:CARPENTER, MICHELLE R (DO)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 HOSPITAL DR.
Mailing Address - Street 2:THE CLARK CLINIC SUITE 200
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391
Mailing Address - Country:US
Mailing Address - Phone:859-737-6480
Mailing Address - Fax:859-737-6641
Practice Address - Street 1:225 HOSPITAL DR.
Practice Address - Street 2:SUITE 200
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391
Practice Address - Country:US
Practice Address - Phone:859-737-6480
Practice Address - Fax:859-737-6641
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY03027207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100014090Medicaid
KY1063385Medicare PIN