Provider Demographics
NPI:1972582955
Name:COMSTOCK, KARRIE ANN (PAC)
Entity Type:Individual
Prefix:MRS
First Name:KARRIE
Middle Name:ANN
Last Name:COMSTOCK
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MS
Other - First Name:KARRIE
Other - Middle Name:ANN
Other - Last Name:KORMANIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PAC
Mailing Address - Street 1:2808 SINGLETARY LAKE CV
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-8572
Mailing Address - Country:US
Mailing Address - Phone:304-692-9338
Mailing Address - Fax:
Practice Address - Street 1:4420 LAKE BOONE TRL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7505
Practice Address - Country:US
Practice Address - Phone:919-784-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-06817363A00000X
WV0715363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0127483000Medicaid
WV0126874000Medicaid
WV3810011004Medicaid
WV0127974000Medicaid
WV0126752000Medicaid
WV3810011004Medicaid
WV0126874000Medicaid