Basic Information
Provider Information | |||||||||
NPI: | 1871540625 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CARTER-POWELL | ||||||||
FirstName: | GARNIE | ||||||||
MiddleName: | JO | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PA-C | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 7995 NW GRUBSTAKE WAY | ||||||||
Address2: |   | ||||||||
City: | REDMOND | ||||||||
State: | OR | ||||||||
PostalCode: | 977568964 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5417490349 | ||||||||
FaxNumber: | 5415042424 | ||||||||
Practice Location | |||||||||
Address1: | 1315 NW 4TH ST | ||||||||
Address2: |   | ||||||||
City: | REDMOND | ||||||||
State: | OR | ||||||||
PostalCode: | 97756 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5415489159 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/27/2006 | ||||||||
LastUpdateDate: | 07/10/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | PA 00691 | OR | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
ID | Type | State | Issuer | Description | 500608031 | 05 | OR |   | MEDICAID | 1871540625 | 01 | OR | NPI | OTHER | PA00691 | 01 | OR | OMB | OTHER |