Provider Demographics
NPI:1285112490
Name:CARTER, ANDREA ELIZABETH (RN)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:ELIZABETH
Last Name:CARTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:ELIZABETH
Other - Last Name:ALLISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1005 FORREST RIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660
Mailing Address - Country:US
Mailing Address - Phone:423-341-9473
Mailing Address - Fax:
Practice Address - Street 1:130 W. RAVINE RD.
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-0911
Practice Address - Country:US
Practice Address - Phone:423-224-4000
Practice Address - Fax:423-224-4746
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000192500163W00000X
TN24999367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse