Healthcare Provider Details

I. General information

NPI: 1235268301
Provider Name (Legal Business Name): JUDITH LEE CARPENTER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 05/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 COURT STREET
KEENE NH
03431
US

IV. Provider business mailing address

590 COURT STREET DH KEENE FAMILY MEDICINE
KEENE NH
03431
US

V. Phone/Fax

Practice location:
  • Phone: 603-354-5454
  • Fax: 603-354-6692
Mailing address:
  • Phone: 802-365-4354
  • Fax: 802-365-9435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0550030895
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number001561
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: