Provider Demographics
NPI:1043477987
Name:CAROSI, JAMIE BETH (PA)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:BETH
Last Name:CAROSI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1030
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-1030
Mailing Address - Country:US
Mailing Address - Phone:304-431-9998
Mailing Address - Fax:304-425-0782
Practice Address - Street 1:403 12TH STREET EXT
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2300
Practice Address - Country:US
Practice Address - Phone:304-431-9998
Practice Address - Fax:304-425-0782
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV432363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVPA31441Medicare PIN