Provider Demographics
NPI:1588697130
Name:MURRELL, CARRIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:
Last Name:MURRELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:DAWN
Other - Last Name:WILHERE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:5447 MAPLE LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25840-6872
Mailing Address - Country:US
Mailing Address - Phone:304-574-6900
Mailing Address - Fax:
Practice Address - Street 1:5447 MAPLE LN
Practice Address - Street 2:SUITE B
Practice Address - City:FAYETTEVILLE
Practice Address - State:WV
Practice Address - Zip Code:25840-6872
Practice Address - Country:US
Practice Address - Phone:304-574-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA680363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100037100Medicaid
OH000000626060OtherANTHEM BCBS
KYP00726123OtherRR MEDICARE
KY000000611992OtherANTHEM BCBS
OHPA33421Medicare PIN