Provider Demographics
NPI:1780298687
Name:VINSON, CARLA RAYE
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:RAYE
Last Name:VINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3341 DINGESS RD
Mailing Address - Street 2:
Mailing Address - City:DINGESS
Mailing Address - State:WV
Mailing Address - Zip Code:25671-0145
Mailing Address - Country:US
Mailing Address - Phone:304-752-7404
Mailing Address - Fax:
Practice Address - Street 1:3341 DINGESS RD
Practice Address - Street 2:
Practice Address - City:DINGESS
Practice Address - State:WV
Practice Address - Zip Code:25671-0145
Practice Address - Country:US
Practice Address - Phone:304-752-7404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant