Basic Information
| Provider Information | |||||||||
| NPI: | 1396787131 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOVATER | ||||||||
| FirstName: | CARRIE | ||||||||
| MiddleName: | JO | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CRNA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | THORNE | ||||||||
| OtherFirstName: | LAJUAN | ||||||||
| OtherMiddleName: | CARRIE JO | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 288 | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358040288 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568806711 | ||||||||
| FaxNumber: | 2568806712 | ||||||||
| Practice Location | |||||||||
| Address1: | 721 MADISON ST SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568806711 | ||||||||
| FaxNumber: | 2568806712 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 07/06/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 1-054750 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 511-57099 | 01 | AL | BCBS LOCATION ID | OTHER | 43098 | 01 | AL | NBCRNA | OTHER | 000055317 | 05 | AL | MEDICAID | 1-054750 | 01 | AL | CRNA | OTHER | 1-054750 | 01 | AL | RN | OTHER |