Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | C3854 | KS |
NPI | 1437163458 |
---|---|
Provider Name | Jay Levis Carter |
First Address | Lansing, KS 66043-1308 |
Second Address | Lansing, KS 66043-1308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 08/07/2007 |