MEDICARE: MISTY CARTER RNFA

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
1	163WR0006X	Registered Nurse First Assistant	758509	TX

General Provider Information

NPI Number	:	1265770192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISTY CARTER RNFA

Provider Business Mailing Address
First Line	:	8901 RANDOM RD UNIT 108
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-2732
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8901 RANDOM RD UNIT 108
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-2732
Country	:	US
Telephone Number	:	817-542-1844
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2013
Last Update Date	:	01/28/2013

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