Wayne Leroy Carpenter II, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA03064 Issued in TX

Practice address

3851 Roger Brooke Dr
Brooke Army Medical Center, McHe-QD/Credentials
Fort Sam Houston, TX 78234-4501

Phone

(210) 295-2460

NPI assigned

Oct 26, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584921600000",
    "number": "1215927686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3851 ROGER BROOKE DR",
            "address_2": "BROOKE ARMY MEDICAL CENTER, MCHE-QD/CREDENTIALS",
            "city": "FORT SAM HOUSTON",
            "state": "TX",
            "postal_code": "782344501",
            "telephone_number": "210-295-2460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3851 ROGER BROOKE DR",
            "address_2": "BROOKE ARMY MEDICAL CENTER, MCHE-QD/CREDENTIALS",
            "city": "FORT SAM HOUSTON",
            "state": "TX",
            "postal_code": "782344501",
            "telephone_number": "210-295-2460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARPENTER",
        "first_name": "WAYNE",
        "middle_name": "LEROY",
        "name_prefix": "Mr.",
        "name_suffix": "II",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-26",
        "last_updated": "2020-03-23",
        "certification_date": "2020-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA03064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Misty Dawn Carlson, DO
• Darrel K. Carlton, MD
• Jalen Carney
• Sarah Nicole Caron, DO
• Sheldon Lyles Carpenter, MD
• Melisa Carrasco, CCM
• Rogelio Carrasco, PA
• Ashley Nicole Carrillo, LCSW
• Lyndsey Bess Carrillo, OTR
• Ashley Suezann Carroll, LCSW, CCTP-II

• All providers in Fort Sam Houston, TX
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.