Provider Demographics
NPI:1376580399
Name:WEST, CARRIE V (PAC)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:V
Last Name:WEST
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 W COURT ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-2879
Mailing Address - Country:US
Mailing Address - Phone:509-545-6620
Mailing Address - Fax:509-545-6842
Practice Address - Street 1:4403 W COURT ST
Practice Address - Street 2:SUITE B
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-2879
Practice Address - Country:US
Practice Address - Phone:509-545-6620
Practice Address - Fax:509-545-6842
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004031363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8321861Medicaid
WAP00377834OtherMEDICARE RR
WAAB06402OtherMEDICARE GROUP PIN
WA8321861Medicaid
WA8863218Medicare PIN