Provider Demographics
NPI:1730625427
Name:CARTER, MARIE (FNP)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-2137
Mailing Address - Country:US
Mailing Address - Phone:931-409-6501
Mailing Address - Fax:
Practice Address - Street 1:1701 N MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2303
Practice Address - Country:US
Practice Address - Phone:931-685-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000185765163WE0003X
TN22345363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency