Provider Demographics
NPI:1578889549
Name:MOHR, CARYN LOUISE (CSA)
Entity Type:Individual
Prefix:
First Name:CARYN
Middle Name:LOUISE
Last Name:MOHR
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1635 KIMBROUGH PARK PL
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2306
Mailing Address - Country:US
Mailing Address - Phone:256-653-0390
Mailing Address - Fax:
Practice Address - Street 1:1635 KIMBROUGH PARK PL
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2306
Practice Address - Country:US
Practice Address - Phone:256-653-0390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical