Provider Demographics
NPI:1952610206
Name:CARPENTER, JAMES WOODWARD (LP)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WOODWARD
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 844715
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-4715
Mailing Address - Country:US
Mailing Address - Phone:417-761-5214
Mailing Address - Fax:
Practice Address - Street 1:1350 E BRADFORD PKWY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4376
Practice Address - Country:US
Practice Address - Phone:417-761-5000
Practice Address - Fax:417-761-5011
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1257103G00000X, 103TH0100X
NMPSY1487103TC0700X
AR15-04P103TC0700X
KS2416103TC0700X, 103TC0700X
IA086489103TC0700X
TX32763103TS0200X, 103TS0200X, 103TS0200X
MO2015016464103TC0700X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1952610206Medicaid
AR1952610206Medicare UPIN
AR1952610206Medicare Oscar/Certification
AR1952610206Medicare PIN
AR1952610206Medicaid