MEDICARE: MRS. CHEKENA DENEICE CARTER FNP-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
1	163WC0200X	Critical Care Medicine Registered Nurse	794019	CA
2	163WC0200X	Critical Care Medicine Registered Nurse	RN128702	AZ
3	363LF0000X	Family Nurse Practitioner	21505	CA
4	363LF0000X	Family Nurse Practitioner	AP4413	AZ

General Provider Information

NPI Number	:	1558651869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHEKENA DENEICE CARTER FNP-C

Provider Business Mailing Address
First Line	:	6611 W PEORIA AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-7000
Country	:	US
Telephone Number	:	602-325-5580
Fax Number	:	415-252-7176

Provider Business Practice Location Address
First Line	:	6611 W PEORIA AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-7000
Country	:	US
Telephone Number	:	602-325-5580
Fax Number	:	415-252-7176

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

Provider Enumeration Date	:	04/08/2011
Last Update Date	:	04/17/2025

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