Healthcare Provider Details

I. General information

NPI: 1205088846
Provider Name (Legal Business Name): VICTORIA LYNN CARPENTER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 01/03/2022
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5452 E BELL RD SUITE 115
SCOTTSDALE AZ
85254
US

IV. Provider business mailing address

1601 E HIGHLAND AVE APT 1139
PHOENIX AZ
85016-4684
US

V. Phone/Fax

Practice location:
  • Phone: 480-467-2273
  • Fax: 602-547-6887
Mailing address:
  • Phone: 602-799-8874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2407
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: