Provider Demographics
NPI:1174047591
Name:BLACK, CARLIE M (PA-C)
Entity type:Individual
Prefix:MS
First Name:CARLIE
Middle Name:M
Last Name:BLACK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:CARLIE
Other - Middle Name:M
Other - Last Name:STRATMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:129 N LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-3757
Mailing Address - Country:US
Mailing Address - Phone:931-762-7232
Mailing Address - Fax:931-762-7234
Practice Address - Street 1:129 N LOCUST AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-3757
Practice Address - Country:US
Practice Address - Phone:931-762-7232
Practice Address - Fax:931-762-7234
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TN5218363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant