Provider Demographics
NPI:1669734968
Name:JOHANS, CARRIE ELISE (MD)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:ELISE
Last Name:JOHANS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CARRIE
Other - Middle Name:ELISE
Other - Last Name:YEAST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12700 SOUTHFORK RD STE 260
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3288
Mailing Address - Country:US
Mailing Address - Phone:314-543-5270
Mailing Address - Fax:314-543-5272
Practice Address - Street 1:12700 SOUTHFORK RD STE 260
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3288
Practice Address - Country:US
Practice Address - Phone:314-543-5270
Practice Address - Fax:314-543-5272
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036142583208800000X, 208800000X
MO2019024779208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2012016529OtherSTATE LICENSE