Active NPI
Vivian Jean Carr, PA-C
- Physician Assistant
- Camden on Gauley, WV
National Provider Identifier
1093900714
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 01039
- Practice address
- 10003 Webster Rd
Camden on Gauley, WV 26208-0069 - Phone
- (304) 226-5725
- Fax
- (304) 226-3274
- NPI assigned
- Sep 6, 2007
- Last updated
- Jan 21, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 01039 | WV | Primary |
| Physician Assistant | 363A00000X | 406 | WV |
Addresses
Primary practice location
10003 Webster Rd
Camden on Gauley, WV 26208-0069
Mailing address
PO Box 69
Camden on Gauley, WV 26208-0069
Phone (304) 226-5725
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01039 | Other | WV | WV BOARD OF MEDICINE |
| 406 | Other | WV | WV BOARD OF OSTEOPATHY |
| 0035222000 | Medicaid | WV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01039 | WV | MD | Physician Assistant |
| 406 | WV | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189036800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1232496000000",
"number": "1093900714",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 69",
"city": "CAMDEN ON GAULEY",
"state": "WV",
"postal_code": "262080069",
"telephone_number": "304-226-5725",
"fax_number": "304-226-3274"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10003 WEBSTER RD",
"city": "CAMDEN ON GAULEY",
"state": "WV",
"postal_code": "262080069",
"telephone_number": "304-226-5725",
"fax_number": "304-226-3274"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARR",
"first_name": "VIVIAN",
"middle_name": "JEAN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-09-06",
"last_updated": "2009-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WV",
"license": "01039",
"primary": true
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WV",
"license": "406",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WV BOARD OF MEDICINE",
"identifier": "01039",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WV BOARD OF OSTEOPATHY",
"identifier": "406",
"state": "WV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0035222000",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Camden on Gauley, WV
- Arrettia J. Bush, D.O.
- Camden on Gauley Medical Center (Camden on Gauley Medical Center Pharmacy)
- Camden on Gauley Medical Center Inc
- Camden on Gauley Medical Center Inc
- Camden on Gauley Medical Center Inc
- Meagan Brooke Cavender, MSW, LGSW
- Emily Susan Clagg, D.O.
- Elizabeth Ann Coffman, FNP-BC
- Stephanie Cool
- Hannah Dorsey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.