Provider Demographics
NPI:1821369067
Name:COLE, CARRIE L (PA-C)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:L
Last Name:COLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3536 VANN RD STE B
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3207
Mailing Address - Country:US
Mailing Address - Phone:058-383-2002
Mailing Address - Fax:
Practice Address - Street 1:3536 VANN RD STE B
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3207
Practice Address - Country:US
Practice Address - Phone:205-838-3356
Practice Address - Fax:205-838-3357
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2024-02-26
Deactivation Date:2019-09-19
Deactivation Code:
Reactivation Date:2019-10-03
Provider Licenses
StateLicense IDTaxonomies
ALPA.818363A00000X
AL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant