Provider Demographics
NPI:1023732492
Name:KLINGMAN, CARLIE
Entity type:Individual
Prefix:
First Name:CARLIE
Middle Name:
Last Name:KLINGMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARLIE
Other - Middle Name:
Other - Last Name:STOCKDALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:402 MOUNT ALLEN DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-6109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:121 N NYES RD STE F
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-3248
Practice Address - Country:US
Practice Address - Phone:717-531-0003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025940363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily