Provider Demographics
NPI:1437235058
Name:CARPENTER, SHARON JEAN (PA-C)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:JEAN
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 1:1530 NEEDMORE RD
Mailing Address - Street 2:STE 300
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414
Mailing Address - Country:US
Mailing Address - Phone:937-277-4274
Mailing Address - Fax:937-277-8476
Practice Address - Street 1:1530 NEEDMORE RD
Practice Address - Street 2:STE 300
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414
Practice Address - Country:US
Practice Address - Phone:937-277-4274
Practice Address - Fax:937-277-8476
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50000376363A00000X
OH50.000376RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0067771Medicaid
OHH053960Medicare PIN