Individual
VIVIAN JEAN CARR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
10003 WEBSTER RD, CAMDEN ON GAULEY, WV 26208-0069
(304) 226-5725
(304) 226-3274
Mailing address
PO BOX 69, CAMDEN ON GAULEY, WV 26208-0069
(304) 226-5725
(304) 226-3274
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
01039
WV
363A00000X
Physician Assistant
406
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0035222000
—
WV
01
—
01039
WV BOARD OF MEDICINE
WV
01
—
406
WV BOARD OF OSTEOPATHY
WV
Enumeration date
09/06/2007
Last updated
01/21/2009
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