Individual
HEATHER N CARPENTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4407 MACCORKLE AVE SE, CHARLESTON, WV 25304-2541
(049) 250-3923
(304) 925-0396
Mailing address
PO BOX 1680, HUNTINGTON, WV 25717-1680
(304) 697-1396
(304) 697-2086
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
01705
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810026906
—
WV
Enumeration date
11/26/2013
Last updated
10/08/2021
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