Provider Demographics
NPI:1144555830
Name:CARTER, HEATHER D (LPN)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:D
Last Name:CARTER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4711 TATERSALL CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-8324
Mailing Address - Country:US
Mailing Address - Phone:614-946-5497
Mailing Address - Fax:
Practice Address - Street 1:524 W. BROAD ST B
Practice Address - Street 2:SOUTHEAST INC PRIMARY CARE AT FRANKLIN STATION
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215
Practice Address - Country:US
Practice Address - Phone:614-224-4850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN135888-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2988174Medicaid