Healthcare Provider Details

I. General information

NPI: 1538565726
Provider Name (Legal Business Name): KALEB CARTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2014
Last Update Date: 03/17/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 PHILADELPHIA PIKE
CLAYMONT DE
19703-2431
US

IV. Provider business mailing address

17 SAWMILL RD
GLEN MILLS PA
19342-2270
US

V. Phone/Fax

Practice location:
  • Phone: 302-317-1531
  • Fax:
Mailing address:
  • Phone: 215-264-5198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0000904
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0000904
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: