Healthcare Provider Details

I. General information

NPI: 1295340552
Provider Name (Legal Business Name): KRISTEN DAWN CARPER MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN DAWN CARPER BA, BSW

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 03/31/2021
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 MALLARD CT
BECKLEY WV
25801-3664
US

IV. Provider business mailing address

28 MALLARD CT
BECKLEY WV
25801-3664
US

V. Phone/Fax

Practice location:
  • Phone: 304-252-8409
  • Fax:
Mailing address:
  • Phone: 304-252-8409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number107285
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: