Healthcare Provider Details

I. General information

NPI: 1801393350
Provider Name (Legal Business Name): ZYLOTES M CARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 04/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5976 HOWDERSHELL RD
HAZELWOOD MO
63042-4108
US

IV. Provider business mailing address

5976 HOWDERSHELL RD
HAZELWOOD MO
63042-4108
US

V. Phone/Fax

Practice location:
  • Phone: 314-299-8926
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2017027257
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: