Provider Demographics
NPI:1528049269
Name:CARTER, PAULA (PA)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 W STUART DR
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-2605
Mailing Address - Country:US
Mailing Address - Phone:276-601-2841
Mailing Address - Fax:276-601-2844
Practice Address - Street 1:812 W STUART DR
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2605
Practice Address - Country:US
Practice Address - Phone:276-238-3318
Practice Address - Fax:276-236-4204
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01100001451363A00000X
NC001000224363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1528049269Medicaid
P52687Medicare UPIN
VA007924B98Medicare PIN
NC2764942Medicare PIN
VAW0007Medicare PIN