Provider Demographics
NPI:1427570928
Name:CARTER, CHELSEA RYANN
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:RYANN
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:RYANN
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:505 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MARMADUKE
Mailing Address - State:AR
Mailing Address - Zip Code:72443-9626
Mailing Address - Country:US
Mailing Address - Phone:573-778-4853
Mailing Address - Fax:
Practice Address - Street 1:6263 HIGHWAY 49 S
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-6093
Practice Address - Country:US
Practice Address - Phone:870-240-0444
Practice Address - Fax:870-240-0444
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist