Healthcare Provider Details

I. General information

NPI: 1053143610
Provider Name (Legal Business Name): RACHEL KATE CARPENTER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NORTH FLORIDA/SOUTH GEORGIA VETERANS HEALTH SYSTEM 5465 SW 34TH ST
GAINESVILLE FL
32608
US

IV. Provider business mailing address

411 NW 26TH ST
GAINESVILLE FL
32607-2633
US

V. Phone/Fax

Practice location:
  • Phone: 719-329-4099
  • Fax:
Mailing address:
  • Phone: 719-329-4099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: