Provider Demographics
NPI:1386864726
Name:BOURGET, CARRIE (PA-C)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:BOURGET
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:PO BOX 5848
Mailing Address - Street 2:
Mailing Address - City:CAREFREE
Mailing Address - State:AZ
Mailing Address - Zip Code:85377-5848
Mailing Address - Country:US
Mailing Address - Phone:480-595-0431
Mailing Address - Fax:480-595-2322
Practice Address - Street 1:36800 N SIDEWINDER RD
Practice Address - Street 2:STE A-4
Practice Address - City:CAREFREE
Practice Address - State:AZ
Practice Address - Zip Code:85377
Practice Address - Country:US
Practice Address - Phone:480-595-0431
Practice Address - Fax:480-595-2322
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ2726363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant