Basic Information
| Provider Information | |||||||||
| NPI: | 1992777957 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARDA | ||||||||
| FirstName: | CARRIE | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2340 KATY LN | ||||||||
| Address2: | |||||||||
| City: | POPLAR BLUFF | ||||||||
| State: | MO | ||||||||
| PostalCode: | 639012300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737767393 | ||||||||
| FaxNumber: | 5737767396 | ||||||||
| Practice Location | |||||||||
| Address1: | 2340 KATY LN | ||||||||
| Address2: | |||||||||
| City: | POPLAR BLUFF | ||||||||
| State: | MO | ||||||||
| PostalCode: | 639012300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737767393 | ||||||||
| FaxNumber: | 5737767396 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2006 | ||||||||
| LastUpdateDate: | 12/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Q9793 | TX | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 130703 | FL | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VG0400X | C168049 | CA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | 207V00000X | 111753 | MO | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 160037153 | 01 | MO | RAILROAD MEDICARE | OTHER | 208567735 | 05 | MO | MEDICAID |