Provider Demographics
NPI:1609642321
Name:KLIMENT, CARLY RUTH (PA-C, RDN, LDN)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:RUTH
Last Name:KLIMENT
Suffix:
Gender:F
Credentials:PA-C, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:U.S NAVAL HOSPITAL OKINAWA
Mailing Address - Street 2:
Mailing Address - City:OKINAWA
Mailing Address - State:JAPAN
Mailing Address - Zip Code:96362
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:U.S NAVAL HOSPITAL OKINAWA, CAMP FOSTER
Practice Address - Street 2:
Practice Address - City:OKINAWA
Practice Address - State:JAPAN
Practice Address - Zip Code:96362
Practice Address - Country:JP
Practice Address - Phone:098-971-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110010192363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant