Provider Demographics
NPI:1568733095
Name:CARROLL, LAURA H (PA-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:H
Last Name:CARROLL
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 1:236 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1348
Mailing Address - Country:US
Mailing Address - Phone:859-498-8160
Mailing Address - Fax:859-274-4312
Practice Address - Street 1:103 COMMONWEALTH DR
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-9644
Practice Address - Country:US
Practice Address - Phone:859-498-7716
Practice Address - Fax:859-497-0044
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1683363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100193720Medicaid