Provider Demographics
NPI:1730467028
Name:MCCAHAN, CARRIE (PA)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:MCCAHAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:HINKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1110 E MISSOURI AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2703
Mailing Address - Country:US
Mailing Address - Phone:480-542-8202
Mailing Address - Fax:480-865-2666
Practice Address - Street 1:1110 E MISSOURI AVE STE 110
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2703
Practice Address - Country:US
Practice Address - Phone:480-542-8202
Practice Address - Fax:480-865-2666
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
AZ49282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant