Healthcare Provider Details

I. General information

NPI: 1740655687
Provider Name (Legal Business Name): NICOLE CARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2015
Last Update Date: 12/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 20TH ST N
BIRMINGHAM AL
35203-3609
US

IV. Provider business mailing address

205 20TH ST N
BIRMINGHAM AL
35203-3609
US

V. Phone/Fax

Practice location:
  • Phone: 205-835-6131
  • Fax:
Mailing address:
  • Phone: 205-835-6131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number06807
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number06807
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number06807
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number06807
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: