Provider Demographics
NPI:1891262929
Name:CARSON, JULIA KATHRYN (PA-C)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:KATHRYN
Last Name:CARSON
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 1:470 COLLINS ST
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:NY
Mailing Address - Zip Code:14414-1466
Mailing Address - Country:US
Mailing Address - Phone:585-226-2640
Mailing Address - Fax:585-226-2206
Practice Address - Street 1:470 COLLINS ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:NY
Practice Address - Zip Code:14414-1466
Practice Address - Country:US
Practice Address - Phone:585-226-2640
Practice Address - Fax:585-226-2206
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25306363AM0700X
NY025603363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical