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General NPI Number Information
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NPI Number | 1174829634
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Entity Type | Individual
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Provider Name | LISA YVONNE CARTER APN
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Gender | Female
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Dates
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Enumeration Date | 02/01/2011
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Last Update Date | 08/30/2016
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Provider Practice Location Address
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Address Line | 112 PEARSON
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City | BENTON
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State | AR
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Zip | 72015-4436
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Country | US
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Telephone | 501-326-6720
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Fax | 501-778-0450
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Provider Business Mailing Address
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Address Line | 112 PEARSON
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City | BENTON
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State | AR
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Zip | 72015-4436
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Country | US
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Telephone | 501-326-6720
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Fax | 501-778-0450
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | R68406
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | A003513
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License Number State | AR
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