Healthcare Provider Details

I. General information

NPI: 1831627652
Provider Name (Legal Business Name): BRANDON IVEY CARTER FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2017
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 851 BOX 340
FPO AE
09834-0004
US

IV. Provider business mailing address

PSC 851 BOX 340
FPO AE
09834-0004
US

V. Phone/Fax

Practice location:
  • Phone: 318-439-6110
  • Fax:
Mailing address:
  • Phone: 318-439-6110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number9366815
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024176115
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number9366815
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: