Provider Demographics
NPI:1649723461
Name:KARRAKER, MARLA G (PA-C)
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:G
Last Name:KARRAKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARLA
Other - Middle Name:
Other - Last Name:BRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2120 N 27TH ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-2191
Mailing Address - Country:US
Mailing Address - Phone:217-423-4300
Mailing Address - Fax:217-423-3428
Practice Address - Street 1:2120 N 27TH ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526
Practice Address - Country:US
Practice Address - Phone:217-423-4300
Practice Address - Fax:217-423-3428
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007823363A00000X
IL085006586363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant