Individual
MR. LARRY DAVID CARNES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1400 E. KINCAID STREET, MOUNT VERNON, WA 98274-4127
(360) 428-6434
(360) 858-4233
Mailing address
1400 E. KINCAID STREET, ATTN: CREDENTIALING, MOUNT VERNON, WA 98274-4127
(360) 428-2500
(360) 428-6485
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA60507481
WA
363AM0700X
Medical Physician Assistant
Primary
PA60507481
WA
363AM0700X
Medical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1649238205
—
WA
Enumeration date
05/03/2006
Last updated
02/20/2015
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