Basic Information
| Provider Information | |||||||||
| NPI: | 1578524492 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HESS | ||||||||
| FirstName: | CARLTON | ||||||||
| MiddleName: | |||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 835 5TH AVE | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172174312 | ||||||||
| FaxNumber: | 7172174314 | ||||||||
| Practice Location | |||||||||
| Address1: | 835 5TH AVENUE | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172630629 | ||||||||
| FaxNumber: | 7172174314 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2006 | ||||||||
| LastUpdateDate: | 10/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN205574L | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 207L00000X | 41453 | WV | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | RN205574L | PA | N | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0068673000 | 05 | WV | MEDICAID | 430064986 | 01 | WV | RAILROAD MEDICARE | OTHER | CAQH | 01 | 11896079 | OTHER |