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General NPI Number Information
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NPI Number | 1295228468
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Entity Type | Individual
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Provider Name | CARLA JEAN ANDERSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/12/2018
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 1325 EASTMORELAND AVE STE 260
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City | MEMPHIS
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State | TN
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Zip | 38104-7549
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Country | US
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Telephone | 901-272-6051
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Fax | 901-266-6443
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Provider Business Mailing Address
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Address Line | 1211 UNION AVE STE 330
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City | MEMPHIS
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State | TN
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Zip | 38104-6655
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 3538
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 3538
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License Number State | TN
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