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NPI Code Detail

MEDICARE: MRS. CARRIE YVONNE KING APRN

MEDICARE: MRS. CARRIE YVONNE KING APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner3007860KY

General Provider Information

NPI Number : 1912247644
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CARRIE YVONNE KING APRN
Provider Business Mailing Address
First Line : 3903 VANTAGE PL
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-6801
Country : US
Telephone Number : 502-356-4377
Fax Number : 888-959-2460
Provider Business Practice Location Address
First Line : 3903 VANTAGE PL
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-6801
Country : US
Telephone Number : 502-356-4377
Fax Number : 888-959-2460
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2013
Last Update Date : 11/05/2019

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