Healthcare Provider Details

I. General information

NPI: 1609929132
Provider Name (Legal Business Name): KARTER NEURO DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 E PROMISE LAND RD
BLYTHEVILLE AR
72315-7713
US

IV. Provider business mailing address

PO BOX 1502
BLYTHEVILLE AR
72316-1502
US

V. Phone/Fax

Practice location:
  • Phone: 210-415-6464
  • Fax: 870-838-7770
Mailing address:
  • Phone: 210-415-6464
  • Fax: 870-838-7770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: MS. LANINA T WATSON
Title or Position: CEO
Credential:
Phone: 210-415-6464