Individual
ROBERTA J CARR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
111 BEVER GRADE, LAPWAI, ID 83540-0367
(208) 843-2271
(208) 843-2658
Mailing address
PO BOX 367, LAPWAI, ID 83540-0367
(208) 843-2271
(208) 843-2658
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA287
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805010100
—
ID
Enumeration date
08/09/2006
Last updated
09/12/2025
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