Healthcare Provider Details

I. General information

NPI: 1386307064
Provider Name (Legal Business Name): MARY CAROLINE CARNES CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY CAROLINE KEMP

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 W MARKHAM ST
LITTLE ROCK AR
72205-7101
US

IV. Provider business mailing address

4301 W MARKHAM ST # 783
LITTLE ROCK AR
72205-7101
US

V. Phone/Fax

Practice location:
  • Phone: 501-686-7236
  • Fax:
Mailing address:
  • Phone: 501-614-2006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number212638
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: