Healthcare Provider Details

I. General information

NPI: 1063604940
Provider Name (Legal Business Name): WILLIAM T CARL APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2322 S MAIN ST
FORT SCOTT KS
66701-3026
US

IV. Provider business mailing address

PO BOX 1832
PITTSBURG KS
66762-1832
US

V. Phone/Fax

Practice location:
  • Phone: 888-777-9170
  • Fax:
Mailing address:
  • Phone: 620-231-9873
  • Fax: 620-231-2808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number46083
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: