Provider Demographics
NPI:1831627652
Name:CARTER, BRANDON IVEY (FNP)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:IVEY
Last Name:CARTER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 851 BOX 340
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09834-0004
Mailing Address - Country:US
Mailing Address - Phone:318-439-6110
Mailing Address - Fax:
Practice Address - Street 1:PSC 851 BOX 340
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09834-0004
Practice Address - Country:US
Practice Address - Phone:318-439-6110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9366815163WE0003X, 363LP2300X
VA0024176115363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner