Provider Demographics
NPI:1265442396
Name:MYERS, CAROL ANN (CRNP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:MYERS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4570 PENNS VALLEY RD
Mailing Address - Street 2:STE 1
Mailing Address - City:SPRING MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:16875-8500
Mailing Address - Country:US
Mailing Address - Phone:814-422-8873
Mailing Address - Fax:814-422-8037
Practice Address - Street 1:4570 PENNS VALLEY RD
Practice Address - Street 2:STE 1
Practice Address - City:SPRING MILLS
Practice Address - State:PA
Practice Address - Zip Code:16875-8500
Practice Address - Country:US
Practice Address - Phone:814-422-8873
Practice Address - Fax:814-422-8037
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP000100B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA161293ZA9KOtherMEDICARE PTAN