Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 0024171953 | VA |
NPI | 1003225293 |
---|---|
Provider Name | Patricia Lynne Carnes |
First Address | Centreville, VA 20120-4130 |
Second Address | South Riding, VA 20152-4239 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2014 |
Last Update Date | 05/05/2017 |