Healthcare Provider Details

I. General information

NPI: 1104574326
Provider Name (Legal Business Name): CARTERS FAMILY PRACTICE AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 OSUNA RD NE STE 600
ALBUQUERQUE NM
87113-0009
US

IV. Provider business mailing address

5021 NELSON PL NW
ALBUQUERQUE NM
87114-4320
US

V. Phone/Fax

Practice location:
  • Phone: 505-441-0214
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BEVERLY CARTER
Title or Position: FNP/OWNER
Credential: FNP
Phone: 505-205-2353