Provider Demographics
NPI:1821230301
Name:CARR, SALLY B (NP)
Entity type:Individual
Prefix:MS
First Name:SALLY
Middle Name:B
Last Name:CARR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:118 FAIRVIEW DR
Mailing Address - Street 2:SOUTHAMPTON MEDICAL BLDG SUITE 100
Mailing Address - City:FRANKLIN
Mailing Address - State:VA
Mailing Address - Zip Code:23851-1250
Mailing Address - Country:US
Mailing Address - Phone:757-562-4156
Mailing Address - Fax:757-562-7989
Practice Address - Street 1:118 FAIRVIEW DR
Practice Address - Street 2:SOUTHAMPTON MEDICAL BLDG SUITE 100
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-1250
Practice Address - Country:US
Practice Address - Phone:757-562-4156
Practice Address - Fax:757-562-7989
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024076017363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024076017OtherNP LICENSE