Healthcare Provider Details

I. General information

NPI: 1265442396
Provider Name (Legal Business Name): CAROL ANN MYERS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4570 PENNS VALLEY RD STE 1
SPRING MILLS PA
16875-8500
US

IV. Provider business mailing address

4570 PENNS VALLEY RD STE 1
SPRING MILLS PA
16875-8500
US

V. Phone/Fax

Practice location:
  • Phone: 814-422-8873
  • Fax: 814-422-8037
Mailing address:
  • Phone: 814-422-8873
  • Fax: 814-422-8037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP000100B
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier161293ZA9K
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerMEDICARE PTAN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: