MEDICARE: CHRISTAL LYNN 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	363LF0000X	Family Nurse Practitioner	1035144	TX

General Provider Information

NPI Number	:	1649915778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTAL LYNN CARTER FNP-C

Provider Business Mailing Address
First Line	:	14701 SAN PEDRO AVE STE 240
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-4355
Country	:	US
Telephone Number	:	210-858-6127
Fax Number	:	726-238-7196

Provider Business Practice Location Address
First Line	:	14701 SAN PEDRO AVE STE 240
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-4355
Country	:	US
Telephone Number	:	210-858-6127
Fax Number	:	726-238-7196

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

Provider Enumeration Date	:	05/03/2022
Last Update Date	:	04/22/2024

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