Provider Demographics
NPI:1447640115
Name:EMORY, CARRIE ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANNE
Last Name:EMORY
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 1:569 32 RD
Mailing Address - Street 2:UNIT 12
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504-7053
Mailing Address - Country:US
Mailing Address - Phone:252-241-3763
Mailing Address - Fax:
Practice Address - Street 1:1124 GALLERY PARK BLVD
Practice Address - Street 2:#200
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412
Practice Address - Country:US
Practice Address - Phone:910-341-3300
Practice Address - Fax:910-251-2067
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05533363A00000X
COPA.0004217363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical