Provider Demographics
NPI:1720337264
Name:CARTER, KATHRENE RENEE (DNP)
Entity type:Individual
Prefix:
First Name:KATHRENE
Middle Name:RENEE
Last Name:CARTER
Suffix:
Gender:
Credentials:DNP
Other - Prefix:
Other - First Name:KATHRENE
Other - Middle Name:CARTER
Other - Last Name:BRENDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP
Mailing Address - Street 1:460 LANGDON ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-1614
Mailing Address - Country:US
Mailing Address - Phone:864-582-2711
Mailing Address - Fax:864-582-7179
Practice Address - Street 1:1200 RIDGEFIELD BLVD STE 250
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-2287
Practice Address - Country:US
Practice Address - Phone:828-633-6070
Practice Address - Fax:828-633-6073
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014214363LP0808X
TN25149363LP0808X
SC17982363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCBP018Medicaid
SC4350OtherMEDICARE PART B GROUP #
SCFQC031Medicaid