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General NPI Number Information
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NPI Number | 1518856772
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Entity Type | Individual
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Provider Name | KATHLEEN ROSE MARKS CARPENTER
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Gender | Female
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Dates
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Enumeration Date | 07/01/2025
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 1350 HICKORY ST
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City | MELBOURNE
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State | FL
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Zip | 32901-3224
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Country | US
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Telephone | 321-327-3540
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Fax |
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Provider Business Mailing Address
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Address Line | 2105 N HIGHWAY A1A
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City | INDIALANTIC
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State | FL
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Zip | 32903-2512
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Country | US
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Telephone | 678-815-4348
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Fax |
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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 | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number |
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License Number State |
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