Provider Demographics
NPI:1902877624
Name:CARVER, ERIN S (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:S
Last Name:CARVER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5985 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-3039
Mailing Address - Country:US
Mailing Address - Phone:208-853-0071
Mailing Address - Fax:208-853-9422
Practice Address - Street 1:6165 W EMERALD STREET
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706
Practice Address - Country:US
Practice Address - Phone:208-377-0777
Practice Address - Fax:208-377-1070
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102051363AM0700X
ID928363A00000X
IDPA-928363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1902877624Medicaid
FL292324600Medicaid
FLE8884TMedicare PIN
FLP00904361Medicare PIN
FLP78155Medicare UPIN
GA003104662AMedicaid
FLE8884UMedicare PIN