Individual
MS. CASEY LYNN CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1551 E MULLAN AVE BLDG A STE 200D, POST FALLS, ID 83854-4868
(208) 618-6070
(208) 618-8903
Mailing address
1593 E POLSTON AVE, POST FALLS, ID 83854
(208) 262-2300
(208) 262-2390
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2000
ID
363A00000X
Physician Assistant
PA150161
OR
363A00000X
Physician Assistant
PA60371391
WA
363AM0700X
Medical Physician Assistant
PA-2000
ID
363AS0400X
Surgical Physician Assistant
PA-2000
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1538331921
—
ID
Enumeration date
03/26/2008
Last updated
05/03/2021
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