Provider Demographics
NPI:1740271048
Name:CARTER, JESSICA A (PT)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:A
Last Name:CARTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 CLEAR SKY CT
Mailing Address - Street 2:C
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5653
Mailing Address - Country:US
Mailing Address - Phone:931-920-4333
Mailing Address - Fax:931-920-4346
Practice Address - Street 1:291 CLEAR SKY CT
Practice Address - Street 2:C
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5653
Practice Address - Country:US
Practice Address - Phone:931-920-4333
Practice Address - Fax:931-920-4346
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6971225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3645585Medicare ID - Type Unspecified