Provider Demographics
NPI:1154563179
Name:CARTER, KIA LASHAUN (MD)
Entity type:Individual
Prefix:DR
First Name:KIA
Middle Name:LASHAUN
Last Name:CARTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KIA
Other - Middle Name:LASHAUN
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:901 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2722
Practice Address - Country:US
Practice Address - Phone:682-885-1050
Practice Address - Fax:682-885-7572
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036-1308732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FC4114017OtherDEA