Provider Demographics
NPI:1174574842
Name:CARTER, REBECCA T (RN, GNP-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:T
Last Name:CARTER
Suffix:
Gender:F
Credentials:RN, GNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 DRYSTONE TRL
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-4364
Mailing Address - Country:US
Mailing Address - Phone:512-992-7622
Mailing Address - Fax:
Practice Address - Street 1:3901A SPICEWOOD SPRINGS RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8723
Practice Address - Country:US
Practice Address - Phone:512-992-7622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX613819363LG0600X
TXAP112948363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F7679Medicare PIN