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General NPI Number Information
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NPI Number | 1154605822
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Entity Type | Individual
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Provider Name | AMBER FANNIN CARPENTER PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/29/2011
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Last Update Date | 12/27/2017
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Provider Practice Location Address
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Address Line | 265 BROOKVIEW CENTRE WAY SUITE 400
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City | KNOXVILLE
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State | TN
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Zip | 37919-4049
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Country | US
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Telephone | 800-342-2898
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Fax |
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Provider Business Mailing Address
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Address Line | 2351 G RD
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City | GRAND JUNCTION
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State | CO
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Zip | 81505-9641
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Country | US
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Telephone | 970-257-6209
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Fax | 970-257-6251
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA1659
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License Number State | KY
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