Provider Demographics
NPI:1528488822
Name:CARTER, PAULA DENISE (OPERATOR)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:DENISE
Last Name:CARTER
Suffix:
Gender:F
Credentials:OPERATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 E 17TH ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-1703
Mailing Address - Country:US
Mailing Address - Phone:316-807-6761
Mailing Address - Fax:316-440-0807
Practice Address - Street 1:5701 E 17TH ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-1703
Practice Address - Country:US
Practice Address - Phone:316-807-6761
Practice Address - Fax:316-440-0807
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSB087203311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home