MEDICARE: MS. RANDI G CARTER PA-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	363AM0700X	Medical Physician Assistant	PA10003174	WA

General Provider Information

NPI Number	:	1629130273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RANDI G CARTER PA-C

Provider Business Mailing Address
First Line	:	9631 N NEVADA ST
Second Line	:	STE 210
City	:	SPOKANE
State	:	WA
Zip	:	99218-1197
Country	:	US
Telephone Number	:	509-979-5105
Fax Number	:

Provider Business Practice Location Address
First Line	:	9631 N NEVADA ST
Second Line	:	SUITE 210
City	:	SPOKANE
State	:	WA
Zip	:	99218-1133
Country	:	US
Telephone Number	:	509-979-5105
Fax Number	:

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

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	03/31/2021

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