Provider Demographics
NPI:1871087155
Name:CARTER, THALIDA
Entity type:Individual
Prefix:
First Name:THALIDA
Middle Name:
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 1:6534 LIGHTHOUSE WAY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75249-2825
Mailing Address - Country:US
Mailing Address - Phone:214-270-4466
Mailing Address - Fax:
Practice Address - Street 1:4121 MARVIN D LOVE FWY STE 2000
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-4863
Practice Address - Country:US
Practice Address - Phone:214-270-4466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health