Provider Demographics
NPI:1578659694
Name:PUGH, CAROLYN KNOWLTON (PA-C)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:KNOWLTON
Last Name:PUGH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2602 COURTIER DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7818
Mailing Address - Country:US
Mailing Address - Phone:252-752-0483
Mailing Address - Fax:252-757-3172
Practice Address - Street 1:2602 COURTIER DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7818
Practice Address - Country:US
Practice Address - Phone:252-752-0483
Practice Address - Fax:252-757-3172
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2024-07-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC103098363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10448Medicare UPIN