Provider Demographics
NPI:1245955822
Name:CARTER, SHANE EMERON (PMHNP, APRN)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:EMERON
Last Name:CARTER
Suffix:
Gender:M
Credentials:PMHNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4516 S 700 E STE 370
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-8317
Mailing Address - Country:US
Mailing Address - Phone:801-918-1786
Mailing Address - Fax:385-449-9998
Practice Address - Street 1:4516 S 700 E STE 370
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-8317
Practice Address - Country:US
Practice Address - Phone:435-776-5909
Practice Address - Fax:435-776-5909
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5710757-44052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry