Provider Demographics
NPI:1962632554
Name:WOODWORTH, CARINNE FRANCES (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CARINNE
Middle Name:FRANCES
Last Name:WOODWORTH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:CARINNE
Other - Middle Name:FRANCES
Other - Last Name:MCKEEVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:110 PRESTON EXECUTIVE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8447
Mailing Address - Country:US
Mailing Address - Phone:919-852-3999
Mailing Address - Fax:919-378-9114
Practice Address - Street 1:110 PRESTON EXECUTIVE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8447
Practice Address - Country:US
Practice Address - Phone:919-852-3999
Practice Address - Fax:919-378-9114
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001-01890363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC5957AMedicare UPIN