Provider Demographics
NPI:1386881456
Name:CARTER, KRISTY L (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:L
Last Name:CARTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:L
Other - Last Name:CARTER-MCCOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1100 REID PARKWAY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-966-1600
Mailing Address - Fax:765-983-3219
Practice Address - Street 1:1434 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1947
Practice Address - Country:US
Practice Address - Phone:765-966-1600
Practice Address - Fax:765-962-9641
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005531RX363A00000X
IN10001055A363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant