Healthcare Provider Details

I. General information

NPI: 1245955822
Provider Name (Legal Business Name): SHANE EMERON CARTER PMHNP, APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 08/30/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4516 S 700 E STE 370
MURRAY UT
84107-8317
US

IV. Provider business mailing address

4516 S 700 E STE 370
MURRAY UT
84107-8317
US

V. Phone/Fax

Practice location:
  • Phone: 435-776-5909
  • Fax: 435-776-5909
Mailing address:
  • Phone: 801-918-1786
  • Fax: 385-449-9998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5710757-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: