Provider Demographics
NPI:1114333572
Name:ROYER, CARRIE KYPER (PA-C)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:KYPER
Last Name:ROYER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:ELIZABETH
Other - Last Name:KYPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:327 LONG LEAF DR
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-2417
Mailing Address - Country:US
Mailing Address - Phone:814-251-4581
Mailing Address - Fax:
Practice Address - Street 1:125 RIVER VINE PKWY
Practice Address - Street 2:
Practice Address - City:WALLACE
Practice Address - State:NC
Practice Address - Zip Code:28466-2377
Practice Address - Country:US
Practice Address - Phone:910-285-2134
Practice Address - Fax:910-285-4610
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001005106363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant