MEDICARE: CRYSTAL CARTER

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	374U00000X	Home Health Aide
2	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1770155392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL CARTER

Provider Business Mailing Address
First Line	:	5371 DAVENPORT LN
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43016-7809
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5371 DAVENPORT LN
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43016-7809
Country	:	US
Telephone Number	:	614-962-0114
Fax Number	:

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

Provider Enumeration Date	:	07/13/2021
Last Update Date	:	07/13/2021

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Directions to “ CRYSTAL CARTER ” Practice Location

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