Provider Demographics
NPI:1063106284
Name:MYRICK CARPENTER, TAMMY LANNETTE (FNP-BC)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:LANNETTE
Last Name:MYRICK CARPENTER
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 1:520 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARSHVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28103-1197
Mailing Address - Country:US
Mailing Address - Phone:704-624-3388
Mailing Address - Fax:704-624-3390
Practice Address - Street 1:520 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARSHVILLE
Practice Address - State:NC
Practice Address - Zip Code:28103-1197
Practice Address - Country:US
Practice Address - Phone:704-624-3388
Practice Address - Fax:704-624-3390
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5018217363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1063106284Medicaid