Provider Demographics
NPI:1306040480
Name:MCPHERSON, CARRIE E (RPA)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:E
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:RPA
Other - Prefix:MS
Other - First Name:CARRIE
Other - Middle Name:E
Other - Last Name:FARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA
Mailing Address - Street 1:18 LIMESTONE DR STE 5
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8602
Mailing Address - Country:US
Mailing Address - Phone:716-632-1400
Mailing Address - Fax:716-632-5316
Practice Address - Street 1:18 LIMESTONE DR STE 5
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-8602
Practice Address - Country:US
Practice Address - Phone:716-632-1400
Practice Address - Fax:716-632-5316
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011592363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY011592OtherLICENSE
NYPA1994Medicare PIN