Provider Demographics
NPI:1952634743
Name:HAUT, KARILYN SUZANNE (PA)
Entity Type:Individual
Prefix:
First Name:KARILYN
Middle Name:SUZANNE
Last Name:HAUT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KARILYN
Other - Middle Name:
Other - Last Name:CROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 16297
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90209-2297
Mailing Address - Country:US
Mailing Address - Phone:805-568-7800
Mailing Address - Fax:
Practice Address - Street 1:310 S HALCYON RD STE 106
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420
Practice Address - Country:US
Practice Address - Phone:805-568-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003571363A00000X
CA54056363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1088882OtherNCCPA BOARD CERTIFICATION ID NUMBER
IL1088882OtherNCCPA BOARD CERTIFICATION ID NUMBER