Provider Demographics
NPI:1457923849
Name:PROBST, KARA
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:PROBST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 MCADOO AVE APT 3D
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-1763
Mailing Address - Country:US
Mailing Address - Phone:770-639-2237
Mailing Address - Fax:
Practice Address - Street 1:603A DOLLEY MADISON RD UNIT 100
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-4205
Practice Address - Country:US
Practice Address - Phone:336-632-3505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-11394363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant