Provider Demographics
NPI:1821203340
Name:PRATER, CAROLYN PEARL (DO)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:PEARL
Last Name:PRATER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4301 DONIPHAN DR
Mailing Address - Street 2:
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850-9120
Mailing Address - Country:US
Mailing Address - Phone:417-451-9450
Mailing Address - Fax:417-451-8903
Practice Address - Street 1:530 S MAIDEN LN
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-3084
Practice Address - Country:US
Practice Address - Phone:417-659-9100
Practice Address - Fax:417-659-9101
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO106608208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics