Provider Demographics
NPI:1194530196
Name:CARROTHERS, KIAH
Entity type:Individual
Prefix:
First Name:KIAH
Middle Name:
Last Name:CARROTHERS
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 1:9803 SPRING PARK DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-5156
Mailing Address - Country:US
Mailing Address - Phone:704-564-9863
Mailing Address - Fax:
Practice Address - Street 1:9803 SPRING PARK DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-5156
Practice Address - Country:US
Practice Address - Phone:704-564-9863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-08
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant