Provider Demographics
NPI:1043947690
Name:CARTER, TRACEY REDINA
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:REDINA
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 LIGHTHOUSE CIR
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3838
Mailing Address - Country:US
Mailing Address - Phone:228-219-3372
Mailing Address - Fax:
Practice Address - Street 1:5400 LIGHTHOUSE CIR
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3838
Practice Address - Country:US
Practice Address - Phone:228-219-3372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)