Carrie Diane Parente, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

46820 Issued in MN

Practice address

250 Central Ave N Ste 114
Wayzata, MN 55391-1232

Phone

(952) 476-0783

Fax

(952) 487-0573

NPI assigned

Sep 27, 2005

Last updated

May 3, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Carrie Diane Clark Former name

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1127779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556841600000",
    "number": "1992791651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 CENTRAL AVE N STE 114",
            "city": "WAYZATA",
            "state": "MN",
            "postal_code": "553911232",
            "telephone_number": "952-476-0783",
            "fax_number": "952-487-0573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 CENTRAL AVE N STE 114",
            "city": "WAYZATA",
            "state": "MN",
            "postal_code": "553911232",
            "telephone_number": "952-476-0783",
            "fax_number": "952-487-0573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARENTE",
        "first_name": "CARRIE",
        "middle_name": "DIANE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-09-27",
        "last_updated": "2019-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MN",
            "license": "46820",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARRIE",
            "last_name": "CLARK",
            "middle_name": "DIANE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Psychiatry Physician in Wayzata, MN
• Providers in Wayzata, MN by specialty
• Psychiatry Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.