Provider Demographics
NPI:1174894232
Name:CARSON, JULIE ANN (PA-C)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANN
Last Name:CARSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:CRISFIELD
Mailing Address - State:MD
Mailing Address - Zip Code:21817-1437
Mailing Address - Country:US
Mailing Address - Phone:443-783-4079
Mailing Address - Fax:
Practice Address - Street 1:24459 SUSSEX HWY
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-4433
Practice Address - Country:US
Practice Address - Phone:302-629-3099
Practice Address - Fax:302-629-6059
Is Sole Proprietor?:No
Enumeration Date:2012-01-21
Last Update Date:2012-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1103759OtherNCCPA CERTIFICATION