Basic Information
| Provider Information | |||||||||
| NPI: | 1093837585 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARTER | ||||||||
| FirstName: | KARYN | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | APRN,BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 119 RUSSELL ST | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 014601274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786791200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 119 RUSSELL ST | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 014601274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786791200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2007 | ||||||||
| LastUpdateDate: | 10/03/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 166854 | MA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 364SP0809X | 166854 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Adult |
ID Information
| ID | Type | State | Issuer | Description | 0377970 | 05 | MA | MEDICAID |