Provider Demographics
NPI:1477571487
Name:CARTER, CHRISTOPHER ENGLEY (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ENGLEY
Last Name:CARTER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 MISTY MOUNTAIN LN
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25312-8041
Mailing Address - Country:US
Mailing Address - Phone:304-610-4718
Mailing Address - Fax:
Practice Address - Street 1:254 MISTY MOUNTAIN LN
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25312-8041
Practice Address - Country:US
Practice Address - Phone:304-610-4718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV730363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1477571487Medicaid
WV1477571487Medicaid
WV1477571487Medicaid
WV3810024049OtherTHS PHYSICIAN PARTNERS, INC GROUP MEDICAID
WV001719863OtherBLUE CROSS BLUE SHIELD
WV1069883OtherWV DWC
WV13809Medicare PIN