Provider Demographics
NPI:1992777957
Name:CARDA, CARRIE LYNN (MD)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:LYNN
Last Name:CARDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 KATY LN
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2300
Mailing Address - Country:US
Mailing Address - Phone:573-776-7393
Mailing Address - Fax:573-776-7396
Practice Address - Street 1:2340 KATY LN
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2300
Practice Address - Country:US
Practice Address - Phone:573-776-7393
Practice Address - Fax:573-776-7396
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL130703207V00000X
TXQ9793207V00000X
CAC168049207VG0400X
MO111753207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO160037153OtherRAILROAD MEDICARE
MO208567735Medicaid