Healthcare Provider Details

I. General information

NPI: 1316516610
Provider Name (Legal Business Name): KATLYN PETERSON CARTER LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

396 NE LITTLE FARM LN
POULSBO WA
98370-4547
US

IV. Provider business mailing address

396 NE LITTLE FARM LN
POULSBO WA
98370-4547
US

V. Phone/Fax

Practice location:
  • Phone: 208-431-3610
  • Fax: 866-441-1456
Mailing address:
  • Phone: 208-431-3610
  • Fax: 866-441-1456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW61101244
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: