Carol Lee Quillen, P.A.-C.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

286 Issued in WY

Practice address

745 Buena Vista Dr
Lander, WY 82520-3431

Phone

(307) 332-2941

Fax

(307) 332-2068

NPI assigned

Oct 4, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/2483/brand/1/csg/1/fhir/r4
• Direct secure messaging: carol.quillen.1@7718.direct.athenahealth.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1093801664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "745 BUENA VISTA DR",
            "city": "LANDER",
            "state": "WY",
            "postal_code": "825203431",
            "telephone_number": "307-332-2941",
            "fax_number": "307-332-2068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "745 BUENA VISTA DR",
            "city": "LANDER",
            "state": "WY",
            "postal_code": "825203431",
            "telephone_number": "307-332-2941",
            "fax_number": "307-332-2068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUILLEN",
        "first_name": "CAROL",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "credential": "P.A.-C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WY",
            "license": "286",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD RETIREM",
            "identifier": "P00137358",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "301811",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julian Poush
• Kimberly Ann Preletz, LCSW
• Donna K Prevett, M.A. CCC-SLP
• Michael W Pryor, M.D.
• Katherine Quayle, DPT
• Deirdre Danette Rainer, PH.D.
• Thomas Rangitsch, M.D.
• Daniel NMN Ratigan, M.D.
• Tonie Marie Ratliff, CSW - 121
• Colleen Redding

• Physician Assistant in Lander, WY
• Providers in Lander, WY by specialty
• Physician Assistant in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.