Provider Demographics
NPI:1881983625
Name:CARTER, JACQUELYN LEIGH (MD)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:LEIGH
Last Name:CARTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:L
Other - Last Name:WHITNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:607 S NEW BALLAS RD STE 2415
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8234
Mailing Address - Country:US
Mailing Address - Phone:314-251-6986
Mailing Address - Fax:314-251-5712
Practice Address - Street 1:607 S NEW BALLAS RD STE 2415
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8234
Practice Address - Country:US
Practice Address - Phone:314-251-6986
Practice Address - Fax:314-251-5712
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010738302080P0207X
MO20200129072080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology