Provider Demographics
NPI:1942718127
Name:CARR, MOLLY ANNE (PA)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:ANNE
Last Name:CARR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CORPORATE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3870
Mailing Address - Country:US
Mailing Address - Phone:800-893-9698
Mailing Address - Fax:
Practice Address - Street 1:5788 STOFFER RD
Practice Address - Street 2:
Practice Address - City:BELLVILLE
Practice Address - State:OH
Practice Address - Zip Code:44813-9112
Practice Address - Country:US
Practice Address - Phone:419-571-7275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005485RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant