Provider Demographics
NPI:1730829672
Name:RAU, CARLY KAY (PA)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:KAY
Last Name:RAU
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1109 TITUS AVE APT B
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3119
Mailing Address - Country:US
Mailing Address - Phone:810-922-3262
Mailing Address - Fax:
Practice Address - Street 1:1225 W FRONT ST STE C
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2368
Practice Address - Country:US
Practice Address - Phone:231-642-5031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2025-08-27
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIXYQ892727864OtherBLUECROSS BLUESHIELD