Provider Demographics
NPI:1962408229
Name:KNIPE, CARRIE SUE (PAC)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:SUE
Last Name:KNIPE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:S
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:814-877-5510
Mailing Address - Fax:814-877-5518
Practice Address - Street 1:101 E WOOD ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3040
Practice Address - Country:US
Practice Address - Phone:864-560-6654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA002163363A00000X
SC2288363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02880931OtherNY MEDICAL ASSISTANCE
PA1765844OtherBLUE SHIELD
SC2477PAMedicaid
PAP00396195OtherRR MEDICARE
SCSC74595019Medicare PIN
NY02880931OtherNY MEDICAL ASSISTANCE
SC2477PAMedicaid
SCSC74599068Medicare PIN