Provider Demographics
NPI:1710951819
Name:DANIEL, KARA BOSHER (PA)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:BOSHER
Last Name:DANIEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5005
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-5505
Mailing Address - Country:US
Mailing Address - Phone:804-752-3041
Mailing Address - Fax:804-752-3776
Practice Address - Street 1:205 HENRY ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005
Practice Address - Country:US
Practice Address - Phone:804-752-3041
Practice Address - Fax:804-752-3776
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002226363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1710951819Medicaid