Healthcare Provider Details

I. General information

NPI: 1346757648
Provider Name (Legal Business Name): CARLA PUCKETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 06/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 WESTFALL RD STE 100
ROCHESTER NY
14618-2628
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 278984
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-9835
  • Fax: 585-461-1321
Mailing address:
  • Phone: 585-784-9277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number676619
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number342614
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: