Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT2695 | AR |
NPI | 1063634608 |
---|---|
Provider Name | Dr. Michelle A Carter |
First Address | Rogers, AR 72758-4524 |
Second Address | Rogers, AR 72758-4524 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 16/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12351026 | CAQH PROVIDER ID (01) | AR |
150403721 | (05) | AR |
5V700 | BLUE CROSS AND BLUE SHIELD (01) | AR |