Provider Demographics
NPI:1477634616
Name:SEDGWICK, CARRINGTON L (PA-C)
Entity Type:Individual
Prefix:
First Name:CARRINGTON
Middle Name:L
Last Name:SEDGWICK
Suffix:
Gender:M
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 1:4962 WREN DR
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-8750
Mailing Address - Country:US
Mailing Address - Phone:907-500-5725
Mailing Address - Fax:
Practice Address - Street 1:4962 WREN DR
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8750
Practice Address - Country:US
Practice Address - Phone:907-500-5725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00948363A00000X
WAPA10005159363A00000X
AK1221363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8475873Medicaid
WA1011388Medicaid
AK1651401Medicaid
WA1011388Medicaid
AK1651401Medicaid