Individual
MRS. KIM MARIE CARLTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
340 S WILLARD ST, COTTONWOOD, AZ 86326-4126
(928) 639-6025
(928) 639-5604
Mailing address
1200 N BEAVER ST, PAYER CREDENTIALING, FLAGSTAFF, AZ 86001-3118
(928) 213-6235
(928) 213-6292
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1856
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
402892
—
AZ
Enumeration date
10/25/2006
Last updated
06/23/2020
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