MEDICARE: JESSICA RENEE CARTER

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	164W00000X	Licensed Practical Nurse	164637	OH

General Provider Information

NPI Number	:	1326970146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA RENEE CARTER

Provider Business Mailing Address
First Line	:	6847 N CHESTNUT ST
Second Line	:
City	:	RAVENNA
State	:	OH
Zip	:	44266-3929
Country	:	US
Telephone Number	:	330-552-4853
Fax Number	:

Provider Business Practice Location Address
First Line	:	6847 N CHESTNUT ST
Second Line	:
City	:	RAVENNA
State	:	OH
Zip	:	44266-3929
Country	:	US
Telephone Number	:	330-552-4853
Fax Number	:

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

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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Directions to “ JESSICA RENEE CARTER ” Practice Location

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