Healthcare Provider Details

I. General information

NPI: 1457412371
Provider Name (Legal Business Name): PATRICIA A CARTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CENTRAL DR SUITE 160
BEDFORD TX
76022-6000
US

IV. Provider business mailing address

1600 CENTRAL DR SUITE 160
BEDFORD TX
76022-6000
US

V. Phone/Fax

Practice location:
  • Phone: 817-268-0104
  • Fax: 817-268-6102
Mailing address:
  • Phone: 817-268-0104
  • Fax: 817-268-6102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number643811
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: