Provider Demographics
NPI:1457953259
Name:CARTER, RICKY JR
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:
Last Name:CARTER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6020 13TH PL NW APT 3
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-5036
Mailing Address - Country:US
Mailing Address - Phone:202-848-0888
Mailing Address - Fax:202-723-1090
Practice Address - Street 1:4201 BUTTERWORTH PL NW APT 422
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4565
Practice Address - Country:US
Practice Address - Phone:240-850-5032
Practice Address - Fax:202-723-1090
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide