Provider Demographics
NPI:1336810241
Name:CARLILE, KALAB (NP)
Entity Type:Individual
Prefix:
First Name:KALAB
Middle Name:
Last Name:CARLILE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 NE 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1319
Mailing Address - Country:US
Mailing Address - Phone:541-471-4106
Mailing Address - Fax:
Practice Address - Street 1:124 NW MIDLAND AVE STE J
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1269
Practice Address - Country:US
Practice Address - Phone:541-476-8859
Practice Address - Fax:541-955-8611
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202109970NP-PP363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology