Healthcare Provider Details

I. General information

NPI: 1245228501
Provider Name (Legal Business Name): KARA DARLENE CARPENTER PA C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARA DARLENE BRYAN PA-C

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 OHIO AVE
CHARLESTON WV
25302-2212
US

IV. Provider business mailing address

104 ALEX LN
CHARLESTON WV
25304-2952
US

V. Phone/Fax

Practice location:
  • Phone: 681-205-8701
  • Fax: 681-208-8702
Mailing address:
  • Phone: 304-734-2040
  • Fax: 304-734-2047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number01058
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number01058
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: