Individual
JEREMY CARPENTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3200 MACCORKLE AVE SE, CHARLESTON, WV 25304-1227
(304) 388-5432
Mailing address
3200 MACCORKLE AVE SE, CHARLESTON, WV 25304-1227
(304) 388-5432
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
SP009322
PA
367500000X
Certified Registered Nurse Anesthetist
57744
WV
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN.CRNA.12311
OH
367500000X
Certified Registered Nurse Anesthetist
COA.12311-NA
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3136529
—
OH
05
—
3810019342
—
WV
Enumeration date
04/20/2007
Last updated
06/23/2025
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