Healthcare Provider Details

I. General information

NPI: 1275469157
Provider Name (Legal Business Name): ELIJAH CARPENTER FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205A HOSPITAL DR
MC KENZIE TN
38201-2024
US

IV. Provider business mailing address

205A HOSPITAL DR
MC KENZIE TN
38201-2024
US

V. Phone/Fax

Practice location:
  • Phone: 731-352-7907
  • Fax: 833-690-3848
Mailing address:
  • Phone: 731-352-7907
  • Fax: 833-690-3848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number42279
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: