Provider Demographics
NPI:1609525575
Name:KEBLES, CARALINE PIERCE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CARALINE
Middle Name:PIERCE
Last Name:KEBLES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:CARALINE
Other - Middle Name:ASHLEY
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2225 HAWKINS ST UNIT 461
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-6602
Mailing Address - Country:US
Mailing Address - Phone:239-322-6868
Mailing Address - Fax:
Practice Address - Street 1:2001 VAIL AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1248
Practice Address - Country:US
Practice Address - Phone:704-304-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-19
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
VA0110008504363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant