Provider Demographics
NPI:1831166297
Name:CONNETT, CARRIE L (DO)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:L
Last Name:CONNETT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:L
Other - Last Name:HIENEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:300 SINGLETON RIDGE RD
Mailing Address - Street 2:ATTN PNS CREDENTIALING
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-9142
Mailing Address - Country:US
Mailing Address - Phone:843-234-6946
Mailing Address - Fax:
Practice Address - Street 1:11899 HIGHWAY 707
Practice Address - Street 2:UNIT A8
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-9735
Practice Address - Country:US
Practice Address - Phone:843-651-0791
Practice Address - Fax:843-651-0816
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC87824207Q00000X
KY02960207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH58001272OtherOHIO MEDICAL LICENSE
611389395OtherTAX ID
1831166297OtherNPI
I71754Medicare UPIN
KY0676506Medicare PIN