Healthcare Provider Details

I. General information

NPI: 1316659311
Provider Name (Legal Business Name): CARLEE MIKA RAYMOND PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2022
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2291 EVELYN BYRD AVE
HARRISONBURG VA
22801-5424
US

IV. Provider business mailing address

2291 EVELYN BYRD AVE
HARRISONBURG VA
22801-5424
US

V. Phone/Fax

Practice location:
  • Phone: 540-534-6335
  • Fax: 833-574-4981
Mailing address:
  • Phone: 540-534-6335
  • Fax: 833-574-4981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: