Provider Demographics
NPI:1770735532
Name:PEACE, CARLA JOBETH (PA-C)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:JOBETH
Last Name:PEACE
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:JOBETH
Other - Last Name:SHELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5220 NORTHSHORE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72118-5297
Mailing Address - Country:US
Mailing Address - Phone:501-663-6645
Mailing Address - Fax:501-663-4877
Practice Address - Street 1:4300 LANDERS RD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2525
Practice Address - Country:US
Practice Address - Phone:501-771-1600
Practice Address - Fax:501-955-2252
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA-445363AM0700X, 363A00000X, 363AS0400X
NC0010-01506363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR202645795Medicaid
TN103I970210Medicaid
TN1141740001Medicare NSC
TN103I970210Medicare PIN