Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 448594 | TX |
NPI | 1013078708 |
---|---|
Provider Name | Carol Ann Jeter |
First Address | Galveston, TX 77555-5302 |
Second Address | New Caney, TX 77357-8373 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 02/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
159333703 | (05) | TX |
Q01862 | (02) | TX |