Healthcare Provider Details

I. General information

NPI: 1992777957
Provider Name (Legal Business Name): CARRIE LYNN CARDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 KATY LN
POPLAR BLUFF MO
63901-2300
US

IV. Provider business mailing address

2340 KATY LN
POPLAR BLUFF MO
63901-2300
US

V. Phone/Fax

Practice location:
  • Phone: 573-776-7393
  • Fax: 573-776-7396
Mailing address:
  • Phone: 573-776-7393
  • Fax: 573-776-7396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number130703
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberQ9793
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberC168049
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number111753
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: