Provider Demographics
NPI:1568094498
Name:KREMER, CARLY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:
Last Name:KREMER
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 1:1880 AMHERST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2917
Mailing Address - Country:US
Mailing Address - Phone:540-662-0306
Mailing Address - Fax:
Practice Address - Street 1:1880 AMHERST ST
Practice Address - Street 2:SUITE 100 AND SUITE 200
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6254
Practice Address - Country:US
Practice Address - Phone:540-662-0306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-09
Last Update Date:2023-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-007654363A00000X
VA0110007654363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty