Provider Demographics
NPI:1801840335
Name:MCCARVER, KRISTA LYNNE (PAC)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:LYNNE
Last Name:MCCARVER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:23081 WARNER ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3976
Mailing Address - Country:US
Mailing Address - Phone:734-625-8222
Mailing Address - Fax:810-765-8169
Practice Address - Street 1:47601 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1233
Practice Address - Country:US
Practice Address - Phone:248-367-8366
Practice Address - Fax:248-465-4651
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2008-09-26
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1065413OtherNCCPA CERTIFICATE NUMBER