Provider Demographics
NPI:1841307816
Name:CARPENTER, ILIANA J (PA)
Entity type:Individual
Prefix:
First Name:ILIANA
Middle Name:J
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3223 COUNTY ROAD 389
Mailing Address - Street 2:
Mailing Address - City:ANSON
Mailing Address - State:TX
Mailing Address - Zip Code:79501-4939
Mailing Address - Country:US
Mailing Address - Phone:325-695-6370
Mailing Address - Fax:325-695-0993
Practice Address - Street 1:6417 CENTRAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5884
Practice Address - Country:US
Practice Address - Phone:325-695-6370
Practice Address - Fax:325-695-1505
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN562363A00000X
NC0010-01810363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3667504Medicare ID - Type Unspecified