Provider Demographics
NPI:1770971533
Name:CARPENTER PRIMARY HEALTHCARE, PLLC
Entity type:Organization
Organization Name:CARPENTER PRIMARY HEALTHCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:ANDRE
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:901-463-0105
Mailing Address - Street 1:1251 WESLEY DR STE 104
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-6442
Mailing Address - Country:US
Mailing Address - Phone:901-348-6426
Mailing Address - Fax:901-207-5178
Practice Address - Street 1:1251 WESLEY DR
Practice Address - Street 2:SUITE 104
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-6442
Practice Address - Country:US
Practice Address - Phone:901-348-6426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-02
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6284363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty