Provider Demographics
NPI:1437133717
Name:MARKS, CAROL CONLEY (PHYSICIANS ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:CONLEY
Last Name:MARKS
Suffix:
Gender:F
Credentials:PHYSICIANS ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5069
Mailing Address - Country:US
Mailing Address - Phone:828-264-4553
Mailing Address - Fax:828-262-3649
Practice Address - Street 1:169 BIRCH ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5069
Practice Address - Country:US
Practice Address - Phone:828-264-4553
Practice Address - Fax:828-262-3649
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101425363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2752640BMedicare PIN
P00846Medicare UPIN