MEDICARE: MRS. VICKI G CARTER APRN, MSN, CDE

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	363LF0000X	Family Nurse Practitioner	APN 5671	TN

Other Identifiers

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

General Provider Information

NPI Number	:	1467459990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICKI G CARTER APRN, MSN, CDE

Provider Business Mailing Address
First Line	:	PO BOX 3889
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37602-3889
Country	:	US
Telephone Number	:	423-794-2457
Fax Number	:	423-283-9480

Provider Business Practice Location Address
First Line	:	150 E BROADWAY
Second Line	:
City	:	NEWPORT
State	:	TN
Zip	:	37821-2329
Country	:	US
Telephone Number	:	423-237-6900
Fax Number	:	423-532-8710

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	01/11/2022

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