Provider Demographics
NPI:1083767693
Name:CARR, CAROLINE GAY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:GAY
Last Name:CARR
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1313 RANCH ROAD 620 S
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-6316
Mailing Address - Country:US
Mailing Address - Phone:512-263-0057
Mailing Address - Fax:512-263-0221
Practice Address - Street 1:1313 RANCH ROAD 620 S
Practice Address - Street 2:SUITE 201
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-6316
Practice Address - Country:US
Practice Address - Phone:512-263-0057
Practice Address - Fax:512-263-0221
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2012-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA07933363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPA16949BMedicare ID - Type Unspecified
CAQ26881Medicare UPIN