Healthcare Provider Details

I. General information

NPI: 1467459990
Provider Name (Legal Business Name): VICKI G CARTER APRN, MSN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E BROADWAY
NEWPORT TN
37821-2329
US

IV. Provider business mailing address

PO BOX 3889
JOHNSON CITY TN
37602-3889
US

V. Phone/Fax

Practice location:
  • Phone: 423-237-6900
  • Fax: 423-532-8710
Mailing address:
  • Phone: 423-794-2457
  • Fax: 423-283-9480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN 5671
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: