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NPI Code Detail

MEDICARE: KELLY CARPENTER RD

MEDICARE: KELLY CARPENTER RD
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
1133V00000XRegistered Dietitian

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144213000
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY CARPENTER RD
Provider Business Mailing Address
First Line : PO BOX 53568
Second Line : SUN HEALTH CLINICS BUSINESS OFFICE
City : PHOENIX
State : AZ
Zip : 85072
Country : US
Telephone Number : 623-544-5075
Fax Number : 623-544-5093
Provider Business Practice Location Address
First Line : 10401 W THUNDERBIRD BLVD
Second Line :
City : SUN CITY
State : AZ
Zip : 85351-3004
Country : US
Telephone Number : 623-876-5455
Fax Number : 623-876-6687
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2005
Last Update Date : 05/05/2008

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Directions to “ KELLY CARPENTER RD” Practice Location

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