Healthcare Provider Details

I. General information

NPI: 1629465281
Provider Name (Legal Business Name): HELEN PRUITT CARTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HELEN FAY PRUITT MD

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 2ND AVE STE B3
BOWLING GREEN KY
42101-1790
US

IV. Provider business mailing address

825 2ND AVE STE B3
BOWLING GREEN KY
42101-1790
US

V. Phone/Fax

Practice location:
  • Phone: 270-901-0629
  • Fax: 270-901-0892
Mailing address:
  • Phone: 270-901-0629
  • Fax: 270-901-0892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number52737
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number52737
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: