Provider Demographics
NPI:1144525395
Name:CARTER, MICKIE (MS, PA-C)
Entity type:Individual
Prefix:
First Name:MICKIE
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 WHITEHEAD RD
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-7737
Mailing Address - Country:US
Mailing Address - Phone:903-724-4266
Mailing Address - Fax:
Practice Address - Street 1:284 HWY 641 N
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:TN
Practice Address - Zip Code:38320
Practice Address - Country:US
Practice Address - Phone:903-724-4266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-19
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1731363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical