Provider Demographics
NPI:1679839302
Name:KENT, CARRIE M (DO)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:M
Last Name:KENT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-2223
Mailing Address - Country:US
Mailing Address - Phone:360-729-1458
Mailing Address - Fax:360-729-3021
Practice Address - Street 1:3400 MAIN ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2223
Practice Address - Country:US
Practice Address - Phone:360-729-1458
Practice Address - Fax:360-729-3021
Is Sole Proprietor?:No
Enumeration Date:2012-04-06
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60531519207Q00000X
CA20A 12442207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine