Healthcare Provider Details

I. General information

NPI: 1962358374
Provider Name (Legal Business Name): KYLAN GARRET CARTER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 HIGHWAY 182 W STE B
STARKVILLE MS
39759-9013
US

IV. Provider business mailing address

1207 HIGHWAY 182 W STE B
STARKVILLE MS
39759-9013
US

V. Phone/Fax

Practice location:
  • Phone: 662-324-1097
  • Fax: 662-324-2412
Mailing address:
  • Phone: 662-324-1097
  • Fax: 662-324-2412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: