=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346582475
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARTER CLINICAL SERVICES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2013
-----------------------------------------------------
Last Update Date | 10/16/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 BOND CEMETERY RD
-----------------------------------------------------
City | DENMARK
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38391-2066
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-394-3499
-----------------------------------------------------
Fax | 877-287-2007
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 93
-----------------------------------------------------
City | YORKVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38389-0093
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-394-3499
-----------------------------------------------------
Fax | 877-287-2007
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. SHEILA JEAN CARTER
-----------------------------------------------------
Credential | RN, MSN, FNP-BC, CWO
-----------------------------------------------------
Telephone | 731-394-3499
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 6510
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------