Healthcare Provider Details

I. General information

NPI: 1497664908
Provider Name (Legal Business Name): YAZMINE CARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11126 N LAKE MIST LN
WILLIS TX
77318-5854
US

IV. Provider business mailing address

11126 N LAKE MIST LN
WILLIS TX
77318-5854
US

V. Phone/Fax

Practice location:
  • Phone: 936-232-2465
  • Fax:
Mailing address:
  • Phone: 936-232-2465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number43746
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: