Provider Demographics
NPI:1194959759
Name:BROWN, CARLA M (PA-C)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 697
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-0697
Mailing Address - Country:US
Mailing Address - Phone:606-886-1173
Mailing Address - Fax:606-886-2193
Practice Address - Street 1:4851 KY ROUTE 321
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-9113
Practice Address - Country:US
Practice Address - Phone:606-886-1173
Practice Address - Fax:606-886-2193
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2019-08-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KYPA1193363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100241120Medicaid