Provider Demographics
NPI:1740359967
Name:CARPENTER, RICHARD FELL (NP-C)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:FELL
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 SAN ELIJO AVENUE
Mailing Address - Street 2:
Mailing Address - City:CARDIFF BY THE SEA
Mailing Address - State:CA
Mailing Address - Zip Code:92007
Mailing Address - Country:US
Mailing Address - Phone:760-944-8877
Mailing Address - Fax:760-944-8897
Practice Address - Street 1:2045 SAN ELIJO AVENUE
Practice Address - Street 2:
Practice Address - City:CARDIFF BY THE SEA
Practice Address - State:CA
Practice Address - Zip Code:92007
Practice Address - Country:US
Practice Address - Phone:760-944-8877
Practice Address - Fax:760-944-8897
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17048111N00000X
CA95000606363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0170480OtherBLUE SHIELD OF CALIFORNIA
CADC0170480OtherBLUE SHIELD OF CALIFORNIA