Basic Information
| Provider Information | |||||||||
| NPI: | 1508990540 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARR | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | LYNNE | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1735 27TH ST WALLER BLDG SUITE B06 | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403568008 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1000 ASHLAND DR STE 103 | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | KY | ||||||||
| PostalCode: | 411017092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6063240098 | ||||||||
| FaxNumber: | 6063240315 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2007 | ||||||||
| LastUpdateDate: | 09/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | APRN.CNP.15543 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | 3008468 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 3008468 | 01 | KY | KY LICENSE | OTHER | H281901 | 01 | OH | MEDICARE | OTHER | APRN.CNP.15543 | 01 | OH | OH LICENSE | OTHER | 0097599 | 05 | OH | MEDICAID | K211770 | 01 | KY | MEDICARE | OTHER | 105923 | 01 | WV | WV LICENSE | OTHER |