Provider Demographics
NPI:1497278451
Name:KNOWLES, CAROLYN STANLEY
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:STANLEY
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 VISTA HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:HUDDLESTON
Mailing Address - State:VA
Mailing Address - Zip Code:24104-4021
Mailing Address - Country:US
Mailing Address - Phone:434-907-6796
Mailing Address - Fax:540-297-4856
Practice Address - Street 1:1419 VISTA HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:HUDDLESTON
Practice Address - State:VA
Practice Address - Zip Code:24104-4021
Practice Address - Country:US
Practice Address - Phone:434-907-6796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-21
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT60432670172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver