Provider Demographics
NPI:1518052695
Name:KARLS, CHARLOTTE S (PA-C)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:S
Last Name:KARLS
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 1:910 RUSH DR
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-9665
Mailing Address - Country:US
Mailing Address - Phone:719-539-6637
Mailing Address - Fax:719-539-5275
Practice Address - Street 1:910 RUSH DR
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-9665
Practice Address - Country:US
Practice Address - Phone:719-539-6637
Practice Address - Fax:719-539-5275
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1320363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO30351031Medicaid
469968Medicare UPIN
469968Medicare ID - Type Unspecified