Healthcare Provider Details

I. General information

NPI: 1154869220
Provider Name (Legal Business Name): TAMARA DENAY CARTER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 GRAHAM RD STE C-2320
FLORISSANT MO
63031-8030
US

IV. Provider business mailing address

1225 GRAHAM RD STE C-1350
FLORISSANT MO
63031-8022
US

V. Phone/Fax

Practice location:
  • Phone: 314-953-6801
  • Fax:
Mailing address:
  • Phone: 314-953-6690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2016044349
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2016044349
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: