Provider Demographics
NPI:1093292278
Name:CARNEY, BRANDON RYAN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:RYAN
Last Name:CARNEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 SALT CREEK LN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-0270
Mailing Address - Country:US
Mailing Address - Phone:270-703-0917
Mailing Address - Fax:
Practice Address - Street 1:1165 CEDAR POINT BLVD STE H
Practice Address - Street 2:
Practice Address - City:CEDAR POINT
Practice Address - State:NC
Practice Address - Zip Code:28584-1030
Practice Address - Country:US
Practice Address - Phone:252-808-6850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-20
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-09315OtherNORTH CAROLINA BOARD OF MEDICAL EXAMINERS
SC3032OtherSOUTH CAROLINA BOARD OF MEDICAL EXAMINERS