Provider Demographics
NPI:1124028246
Name:FRAY, CARLA RENEE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:RENEE
Last Name:FRAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:CARLA
Other - Middle Name:R
Other - Last Name:LYDIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:101 FINANCIAL PL STE 104
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-8481
Mailing Address - Country:US
Mailing Address - Phone:270-765-5127
Mailing Address - Fax:270-765-5337
Practice Address - Street 1:101 FINANCIAL PL STE 104
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-8481
Practice Address - Country:US
Practice Address - Phone:270-765-5127
Practice Address - Fax:270-765-5337
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA377363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant