Provider Demographics
NPI:1023738267
Name:CARPENTER, MARY C (LVN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:C
Other - Last Name:CARPENTER DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6108 BALCONY DR APT 914
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4167
Mailing Address - Country:US
Mailing Address - Phone:817-879-2163
Mailing Address - Fax:
Practice Address - Street 1:700 HEMPHILL ST STE A
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3105
Practice Address - Country:US
Practice Address - Phone:817-334-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX166212164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse