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General NPI Number Information
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NPI Number | 1952089302
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Entity Type | Individual
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Provider Name | WILLIAM KENNETH CARTER
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Gender | Male
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Dates
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Enumeration Date | 07/06/2023
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Last Update Date | 07/06/2023
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Provider Practice Location Address
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Address Line | 219 STUDENT UNION HALL
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City | STILLWATER
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State | OK
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Zip | 74078-7040
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Country | US
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Telephone | 405-744-7714
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Fax | 405-744-7754
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Provider Business Mailing Address
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Address Line | 700 W HALL OF FAME AVE
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City | STILLWATER
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State | OK
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Zip | 74074
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Country | US
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Telephone | 703-587-7004
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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 | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 1264
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License Number State | OK
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