Provider Demographics
NPI:1063738938
Name:GRAHAM, CARLA STAHL (NP-C)
Entity type:Individual
Prefix:MS
First Name:CARLA
Middle Name:STAHL
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:CARLA
Other - Middle Name:STAHL
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:10317 OCEAN HIGHWAY
Mailing Address - Street 2:CVS MINUTE CLINIC
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585
Mailing Address - Country:US
Mailing Address - Phone:843-237-4036
Mailing Address - Fax:843-237-2736
Practice Address - Street 1:10317 OCEAN HIGHWAY
Practice Address - Street 2:CVS MINUTE CLINIC
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585
Practice Address - Country:US
Practice Address - Phone:843-235-0267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF4188363LF0000X
SC4188363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1621Medicaid
SC1621Medicaid