Provider Demographics
NPI:1326080540
Name:CARPENTER, CHRISTINE V (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:V
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 1:8901 W GAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-5600
Mailing Address - Country:US
Mailing Address - Phone:509-735-1100
Mailing Address - Fax:509-735-1180
Practice Address - Street 1:8901 W GAGE BLVD
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-5600
Practice Address - Country:US
Practice Address - Phone:509-735-1100
Practice Address - Fax:509-735-1180
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004837363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8332157Medicaid
S71186Medicare UPIN
WA8332157Medicaid