Healthcare Provider Details

I. General information

NPI: 1609642321
Provider Name (Legal Business Name): CARLY RUTH KLIMENT PA-C, RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

U.S NAVAL HOSPITAL OKINAWA, CAMP FOSTER
OKINAWA JAPAN
96362
JP

IV. Provider business mailing address

U.S NAVAL HOSPITAL OKINAWA
OKINAWA JAPAN
96362
JP

V. Phone/Fax

Practice location:
  • Phone: 98-971-9355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110010192
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: