Provider Demographics
NPI:1972841518
Name:VAN ALTHUIS, KARIS ANNETTE (PA-C)
Entity Type:Individual
Prefix:
First Name:KARIS
Middle Name:ANNETTE
Last Name:VAN ALTHUIS
Suffix:
Gender:F
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 1:9101 OCEAN HWY E
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-7867
Mailing Address - Country:US
Mailing Address - Phone:910-371-0404
Mailing Address - Fax:910-371-1005
Practice Address - Street 1:9101 OCEAN HWY E
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-7867
Practice Address - Country:US
Practice Address - Phone:910-371-0404
Practice Address - Fax:910-371-1005
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001004027363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant