Healthcare Provider Details

I. General information

NPI: 1306917455
Provider Name (Legal Business Name): JEANETTE MILLNER CARPENTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS JEANETTE DENISE MILLNER

II. Dates (important events)

Enumeration Date: 11/12/2006
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7107 JAHNKE RD
RICHMOND VA
23225-4017
US

IV. Provider business mailing address

5609 BACKWATER TER
RICHMOND VA
23234-7728
US

V. Phone/Fax

Practice location:
  • Phone: 804-320-4967
  • Fax: 804-320-7130
Mailing address:
  • Phone: 804-275-3547
  • Fax: 804-320-7130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2016-01649
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number076661
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME129023
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.129613
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number268881
License Number StateMA
# 6
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMED-PHYS-LIC-59700
License Number StateMT
# 7
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC152401
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR8537
License Number StateTX
# 9
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0059514
License Number StateCO
# 10
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number55143
License Number StateAZ
# 11
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2017-0961
License Number StateNM
# 12
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11310A
License Number StateWY
# 13
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM-13900
License Number StateID
# 14
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-19484
License Number StateHI
# 15
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101239053
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: