Provider Demographics
NPI:1386970614
Name:CHENOWETH, STAR RAY (PA-C)
Entity type:Individual
Prefix:MR
First Name:STAR
Middle Name:RAY
Last Name:CHENOWETH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:973 MICA DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89705-7255
Mailing Address - Country:US
Mailing Address - Phone:775-783-6190
Mailing Address - Fax:775-783-6191
Practice Address - Street 1:973 MICA DR
Practice Address - Street 2:SUITE 201
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89705-7255
Practice Address - Country:US
Practice Address - Phone:775-783-6190
Practice Address - Fax:775-783-6191
Is Sole Proprietor?:No
Enumeration Date:2009-10-21
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVPA1183363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical