Provider Demographics
NPI:1306917455
Name:CARPENTER, JEANETTE MILLNER (MD)
Entity type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:MILLNER
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:JEANETTE
Other - Middle Name:DENISE
Other - Last Name:MILLNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5609 BACKWATER TER
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23234-7728
Mailing Address - Country:US
Mailing Address - Phone:804-275-3547
Mailing Address - Fax:804-320-7130
Practice Address - Street 1:7107 JAHNKE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4017
Practice Address - Country:US
Practice Address - Phone:804-320-4967
Practice Address - Fax:804-320-7130
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2016-01649207Q00000X
GA076661207Q00000X
FLME129023207Q00000X
OH35.129613207Q00000X
MA268881207Q00000X
MTMED-PHYS-LIC-59700207Q00000X
CAC152401207Q00000X
TXR8537207Q00000X
CODR.0059514207Q00000X
AZ55143207Q00000X
NMMD2017-0961207Q00000X
WY11310A207Q00000X
IDM-13900207Q00000X
HIMD-19484207Q00000X
VA0101239053207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty