Healthcare Provider Details

I. General information

NPI: 1134589104
Provider Name (Legal Business Name): JANELL CARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 E. K-31 HWY.
MELVERN KS
66510
US

IV. Provider business mailing address

PO BOX 284
TOWANDA KS
67144-0284
US

V. Phone/Fax

Practice location:
  • Phone: 620-757-1656
  • Fax:
Mailing address:
  • Phone: 620-757-1656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: