Provider Demographics
NPI:1730247271
Name:SPARE, CARLA K (CRNA)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:K
Last Name:SPARE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:K
Other - Last Name:HOBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-0432
Mailing Address - Country:US
Mailing Address - Phone:606-430-3500
Mailing Address - Fax:606-437-1033
Practice Address - Street 1:911 BYPASS RD BLDG A
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1689
Practice Address - Country:US
Practice Address - Phone:606-430-3500
Practice Address - Fax:606-437-1033
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY810A367500000X
KY3000810367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100320190AMedicaid
KY000000196023OtherANTHEM
KY1051974Medicaid
KY74350547Medicaid
IN100320190AMedicaid
KY3403793Medicare PIN
KY1269230Medicare ID - Type UnspecifiedMEDICARE
KY2433164000Medicare ID - Type UnspecifiedPASSPORT ADVANTAGE
KY000000196023OtherANTHEM