Provider Demographics
NPI:1891312682
Name:SUMPTER, CHARLES (PA-C)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:SUMPTER
Suffix:
Gender:M
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 1:3325 RESEARCH WAY
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-7913
Mailing Address - Country:US
Mailing Address - Phone:775-888-6610
Mailing Address - Fax:
Practice Address - Street 1:762 14TH ST
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-3413
Practice Address - Country:US
Practice Address - Phone:775-738-5850
Practice Address - Fax:775-738-5856
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA2368363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPA2368OtherPHYSICIAN ASSISTANT LICENSE - NEVADA