MEDICARE: CERIK CARTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2255A2300X	Athletic Trainer
2	390200000X	Student in an Organized Health Care Education/Training Program
3	222Z00000X	Orthotist

General Provider Information

NPI Number	:	1336603620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CERIK CARTER

Provider Business Mailing Address
First Line	:	7004 N FARM ROAD 79
Second Line	:
City	:	WILLARD
State	:	MO
Zip	:	65781-9222
Country	:	US
Telephone Number	:	417-631-6127
Fax Number	:

Provider Business Practice Location Address
First Line	:	3003 S KANSAS EXPY
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-5969
Country	:	US
Telephone Number	:	417-883-5522
Fax Number	:

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

Provider Enumeration Date	:	01/30/2019
Last Update Date	:	02/19/2024

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Directions to “ CERIK CARTER ” Practice Location

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