Provider Demographics
NPI:1861265233
Name:CARTER, CHINIQUA L (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:CHINIQUA
Middle Name:L
Last Name:CARTER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8217 ROSEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-6633
Mailing Address - Country:US
Mailing Address - Phone:216-376-1002
Mailing Address - Fax:
Practice Address - Street 1:1400 WSW LOOP 323 STE 60
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-7059
Practice Address - Country:US
Practice Address - Phone:903-526-4875
Practice Address - Fax:903-526-4876
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1018695363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty