Individual
LARRY RENN CARPENTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
100 3RD ST STE 1, DAVENPORT, WA 99122-5008
(509) 725-7501
(509) 725-7501
Mailing address
100 3RD ST STE 1, DAVENPORT, WA 99122-5008
(509) 725-7501
(509) 725-7501
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA60136165
WA
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2005809
—
WA
01
—
295800
WASHINGTON STATE DEPT OF LABOR & INDUSTRIES
WA
Enumeration date
12/13/2005
Last updated
03/23/2020
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