Provider Demographics
NPI:1518035286
Name:CARPENTER, PHYLLIS DIANNE (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:DIANNE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:MISS
Other - First Name:PHYLLIS
Other - Middle Name:DIANNE
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:227 HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-2228
Mailing Address - Country:US
Mailing Address - Phone:276-236-2909
Mailing Address - Fax:276-236-8845
Practice Address - Street 1:227 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2228
Practice Address - Country:US
Practice Address - Phone:276-236-2909
Practice Address - Fax:276-236-8845
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024066376363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily