MEDICARE: MRS. CAROLYN C GARTNER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	0110840186	VA
2	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1073592705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROLYN C GARTNER PA-C

Provider Business Mailing Address
First Line	:	509 NORTHWOOD CIR
Second Line	:
City	:	CROSS JUNCTION
State	:	VA
Zip	:	22625-2537
Country	:	US
Telephone Number	:	540-539-6656
Fax Number	:

Provider Business Practice Location Address
First Line	:	509 NORTHWOOD CIR
Second Line	:
City	:	CROSS JUNCTION
State	:	VA
Zip	:	22625-2537
Country	:	US
Telephone Number	:	304-579-7960
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	06/16/2025

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