Healthcare Provider Details

I. General information

NPI: 1679172704
Provider Name (Legal Business Name): CARRIE VLASIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARRIE ADAMS

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 977
HURRICANE WV
25526-0977
US

IV. Provider business mailing address

PO BOX 977
HURRICANE WV
25526-0977
US

V. Phone/Fax

Practice location:
  • Phone: 681-235-7156
  • Fax: 800-901-7511
Mailing address:
  • Phone: 681-235-7156
  • Fax: 800-901-7511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: