Provider Demographics
NPI:1649156282
Name:STINE, CARRIE ATHENA (FNP)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:ATHENA
Last Name:STINE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:ATHENA
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25180 COLT RD
Mailing Address - Street 2:
Mailing Address - City:LOS MOLINOS
Mailing Address - State:CA
Mailing Address - Zip Code:96055-9676
Mailing Address - Country:US
Mailing Address - Phone:530-953-8983
Mailing Address - Fax:
Practice Address - Street 1:1531 ESPLANADE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3310
Practice Address - Country:US
Practice Address - Phone:530-332-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95036601363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner