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NPI Code Detail

MEDICARE: MRS. KRISTA N. CARTER PA-C

MEDICARE: MRS. KRISTA N. CARTER PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant2015009297MO
2363A00000XPhysician Assistant10001633AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12015009297OTHERMOLICENSE NO
22015009297OTHERMOSTATE LICENSE

General Provider Information

NPI Number : 1043622277
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KRISTA N. CARTER PA-C
Provider Business Mailing Address
First Line : PO BOX 74008272
Second Line :
City : CHICAGO
State : IL
Zip : 60674-8272
Country : US
Telephone Number : 702-899-0595
Fax Number : 702-977-1496
Provider Business Practice Location Address
First Line : 7068 S OUTER 364
Second Line :
City : O FALLON
State : MO
Zip : 63368-7757
Country : US
Telephone Number : 636-240-6100
Fax Number : 636-240-1182
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2014
Last Update Date : 10/07/2025

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