Provider Demographics
NPI:1982210514
Name:OUVERSON, CARLY KRISTINE (PA-C)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:KRISTINE
Last Name:OUVERSON
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 1:4582 335TH ST
Mailing Address - Street 2:
Mailing Address - City:FERTILE
Mailing Address - State:IA
Mailing Address - Zip Code:50434-8701
Mailing Address - Country:US
Mailing Address - Phone:641-529-0691
Mailing Address - Fax:
Practice Address - Street 1:3315 N SEMINARY ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-1251
Practice Address - Country:US
Practice Address - Phone:309-344-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.008903363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical