1689106783 NPI number — ASHLEY CARTER

Table of content: ASHLEY CARTER (NPI 1689106783)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689106783 NPI number — ASHLEY CARTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARTER
Provider First Name:
ASHLEY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689106783
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6726 83RD STREET CT SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98499-2564
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-376-5733
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1570 WILMINGTON DR STE 220
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUPONT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98327-8773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-453-4882
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  BA61193706 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 111524501 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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