Healthcare Provider Details

I. General information

NPI: 1316409139
Provider Name (Legal Business Name): MARY AUGUSTA CARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 FOREST AVE STE 100
RICHMOND VA
23229-4933
US

IV. Provider business mailing address

7601 FOREST AVE STE 100
RICHMOND VA
23229-4933
US

V. Phone/Fax

Practice location:
  • Phone: 804-282-9479
  • Fax:
Mailing address:
  • Phone: 804-282-9479
  • Fax: 804-282-9619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001252257
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number0024181226
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: