Healthcare Provider Details

I. General information

NPI: 1568538015
Provider Name (Legal Business Name): MARY KAYE CARTER ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2862 S CIRCLE DR
COLORADO SPRINGS CO
80906-4101
US

IV. Provider business mailing address

974 8TH ST
PENROSE CO
81240-9555
US

V. Phone/Fax

Practice location:
  • Phone: 719-269-4741
  • Fax: 719-269-4740
Mailing address:
  • Phone: 719-269-4741
  • Fax: 719-269-4740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number77477
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number77477
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: