Provider Demographics
NPI:1245228501
Name:CARPENTER, KARA DARLENE (PA C)
Entity Type:Individual
Prefix:MRS
First Name:KARA
Middle Name:DARLENE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:MS
Other - First Name:KARA
Other - Middle Name:DARLENE
Other - Last Name:BRYAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:2 STONECREST DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-9391
Mailing Address - Country:US
Mailing Address - Phone:304-525-2273
Mailing Address - Fax:304-525-2165
Practice Address - Street 1:2 STONECREST DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-9391
Practice Address - Country:US
Practice Address - Phone:304-525-2273
Practice Address - Fax:304-525-2165
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01058363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1245228501Medicaid
OH0107132Medicaid
WV001720818OtherBLUE CROSS BLUE SHIELD
KY7100274210Medicaid
WV1069109OtherWV DWC
Q18213Medicare UPIN
WVWV0303CMedicare PIN
OH#0107134Medicaid