=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427776319
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARPENTER HEALTH PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2022
-----------------------------------------------------
Last Update Date | 07/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1268 BRIDGE ST
-----------------------------------------------------
City | CLARKSTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99403-2219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-758-9524
-----------------------------------------------------
Fax | 509-758-8258
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1268 BRIDGE ST
-----------------------------------------------------
City | CLARKSTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99403-2219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-758-9524
-----------------------------------------------------
Fax | 509-758-8258
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TODD CARPENTER
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 509-758-9524
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------