Provider Demographics
NPI:1508860271
Name:CARPENTER, LALISA ANN (FNP-C)
Entity type:Individual
Prefix:MS
First Name:LALISA
Middle Name:ANN
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 96860
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28296-6860
Mailing Address - Country:US
Mailing Address - Phone:828-287-0200
Mailing Address - Fax:
Practice Address - Street 1:144 RESERVATION DR
Practice Address - Street 2:
Practice Address - City:SPINDALE
Practice Address - State:NC
Practice Address - Zip Code:28160-1566
Practice Address - Country:US
Practice Address - Phone:828-287-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201661363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000823Medicaid
NC1508860271Medicaid
NC1508860271Medicaid