Provider Demographics
NPI:1134382435
Name:CARTER, JEANEAN M (CNM)
Entity type:Individual
Prefix:
First Name:JEANEAN
Middle Name:M
Last Name:CARTER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5769 FM 546
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:TX
Mailing Address - Zip Code:75407-4765
Mailing Address - Country:US
Mailing Address - Phone:214-578-0733
Mailing Address - Fax:
Practice Address - Street 1:UT SOUTHWESTERN OB-GYN 5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-5513
Practice Address - Country:US
Practice Address - Phone:214-578-0733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX651429367A00000X
TXL4851367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L4185Medicare UPIN