Provider Demographics
NPI:1316516610
Name:CARTER, KATLYN PETERSON (LM, CPM)
Entity type:Individual
Prefix:
First Name:KATLYN
Middle Name:PETERSON
Last Name:CARTER
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 NE LITTLE FARM LN
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-4547
Mailing Address - Country:US
Mailing Address - Phone:208-431-3610
Mailing Address - Fax:866-441-1456
Practice Address - Street 1:396 NE LITTLE FARM LN
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-4547
Practice Address - Country:US
Practice Address - Phone:208-431-3610
Practice Address - Fax:866-441-1456
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW61101244176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife