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General NPI Number Information
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NPI Number | 1831760909
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Entity Type | Individual
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Provider Name | COREY CARR PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/08/2021
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Last Update Date | 11/01/2022
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Provider Practice Location Address
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Address Line | 805 W ACEQUIA AVE STE 1B
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City | VISALIA
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State | CA
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Zip | 93291-6163
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Country | US
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Telephone | 559-406-4720
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Fax |
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Provider Business Mailing Address
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Address Line | 328 E SAN JOAQUIN AVE UNIT 2
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City | TULARE
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State | CA
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Zip | 93274-4162
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 61876
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License Number State | CA
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