MEDICARE: JENNA CARTER APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	5021876	NC
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	30061	SC

General Provider Information

NPI Number	:	1245037316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA CARTER APRN

Provider Business Mailing Address
First Line	:	1817 ETHEL GUEST LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28206-2922
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4609 CHARLOTTE HWY
Second Line	:
City	:	LAKE WYLIE
State	:	SC
Zip	:	29710-8094
Country	:	US
Telephone Number	:	803-228-4038
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2025
Last Update Date	:	11/11/2025

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Directions to “ JENNA CARTER APRN” Practice Location

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