Provider Demographics
NPI:1538648258
Name:YORK, CARSON RYAN (PA)
Entity Type:Individual
Prefix:
First Name:CARSON
Middle Name:RYAN
Last Name:YORK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 648
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:AR
Mailing Address - Zip Code:72576-0648
Mailing Address - Country:US
Mailing Address - Phone:870-895-3238
Mailing Address - Fax:
Practice Address - Street 1:115 TURNER LN
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:AR
Practice Address - Zip Code:72576-5600
Practice Address - Country:US
Practice Address - Phone:870-895-3238
Practice Address - Fax:870-895-3356
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical