Provider Demographics
NPI:1558470369
Name:CARMER, KATHLEEN (FNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:CARMER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 FOWLER WAY
Mailing Address - Street 2:SUITE 7
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-5738
Mailing Address - Country:US
Mailing Address - Phone:530-295-0608
Mailing Address - Fax:530-295-0371
Practice Address - Street 1:1000 FOWLER WAY
Practice Address - Street 2:SUITE 7
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5738
Practice Address - Country:US
Practice Address - Phone:530-295-0608
Practice Address - Fax:530-295-0371
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF332285207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ03572ZMedicare ID - Type Unspecified