Provider Demographics
NPI:1770941841
Name:UMBERGER, CARRIE MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:MARIE
Last Name:UMBERGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:MARIE
Other - Last Name:UMBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1441 OCHSNER BLVD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-8110
Mailing Address - Country:US
Mailing Address - Phone:985-400-5551
Mailing Address - Fax:985-400-5428
Practice Address - Street 1:1441 OCHSNER BLVD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8110
Practice Address - Country:US
Practice Address - Phone:985-400-5551
Practice Address - Fax:985-400-5428
Is Sole Proprietor?:No
Enumeration Date:2016-02-04
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA324102363A00000X
SC2459363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant