Individual provider Active NPI

Mary Anne Carter, C.N.P.

  • Obstetrics & Gynecology Nurse Practitioner
  • Plattsburgh, NY
National Provider Identifier
1093711764
Registry record updated Jan 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology Nurse PractitionerTaxonomy code 363LX0001X
License
F300505 Issued in NY
Practice address
25 Degrandpre Way
Plattsburgh, NY 12901-6449
Phone
(518) 563-3260
Fax
(518) 561-2877
NPI assigned
Jun 27, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Nurse Practitioner 363LX0001X F300505 NY Primary

Addresses

Primary practice location

25 Degrandpre Way
Plattsburgh, NY 12901-6449

Mailing address

25 Degrandpre Way
Plattsburgh, NY 12901-6449
Phone (518) 563-3260

Other identifiers 1

IdentifierTypeStateIssuer
01461018MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
300505NYMDInternal Medicine Physician
F300505NYMDObstetrics & Gynecology Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1263772800000",
    "number": "1093711764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 DEGRANDPRE WAY",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "129016449",
            "telephone_number": "518-563-3260",
            "fax_number": "518-561-2877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 DEGRANDPRE WAY",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "129016449",
            "telephone_number": "518-563-3260",
            "fax_number": "518-561-2877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARTER",
        "first_name": "MARY",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "C.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-27",
        "last_updated": "2010-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "NY",
            "license": "F300505",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01461018",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plattsburgh, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.