Provider Demographics
NPI:1154661965
Name:THOMAS, CARRIE HARRELL (PA-C)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:HARRELL
Last Name:THOMAS
Suffix:
Gender:F
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 1:15441 US HIGHWAY 17 STE 501
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-0016
Mailing Address - Country:US
Mailing Address - Phone:910-685-7307
Mailing Address - Fax:910-506-4699
Practice Address - Street 1:15441 US HIGHWAY 17 STE 501
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-0016
Practice Address - Country:US
Practice Address - Phone:910-685-7307
Practice Address - Fax:910-685-7284
Is Sole Proprietor?:No
Enumeration Date:2013-02-15
Last Update Date:2020-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04105363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant