Doctor Name: | CRISTY DAWN CARPENTER |
NPI Number: | 1891154951 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 68388 |
Business Practice Address: | 78 Queens Alley Rd Rock Cave, WV - 262345890 |
Business Phone Number: | 3049246262 |
Business Fax Number: | 3049245460 |
Mailing Address: | Po Box 217, ROCK CAVE |
State: | WV |
Postal Code: | 262340217 |
Phone Number: | 3049246262 |
Fax Number: | 3049245460 |
NPI Enumeration Date: | 02/17/2016 |
NPI Last Update Date: | 02/17/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 68388 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |