Provider Demographics
NPI:1235136649
Name:CARPENTER, LAURA RENEE (PA-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:RENEE
Last Name:CARPENTER
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 1:10122 COBBLESTONE AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-9397
Mailing Address - Country:US
Mailing Address - Phone:661-865-0211
Mailing Address - Fax:
Practice Address - Street 1:10122 COBBLESTONE AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-9397
Practice Address - Country:US
Practice Address - Phone:661-865-0211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1560363A00000X
CAPA20721363A00000X
NC0010-00132363A00000X
OH50001934363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH92666Medicare UPIN
OH77431Medicare ID - Type UnspecifiedMEDICARE