Provider Demographics
NPI:1245558923
Name:CARVER, KELLI (PA-C)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:CARVER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:
Other - Last Name:LINNERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1561 CREEKSIDE DR
Mailing Address - Street 2:#150
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3492
Mailing Address - Country:US
Mailing Address - Phone:916-983-2193
Mailing Address - Fax:916-983-2193
Practice Address - Street 1:1561 CREEKSIDE DR
Practice Address - Street 2:#150
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3492
Practice Address - Country:US
Practice Address - Phone:916-983-2193
Practice Address - Fax:916-983-2193
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20911363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant