Healthcare Provider Details

I. General information

NPI: 1508245960
Provider Name (Legal Business Name): JODI LYNN CARNEY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JODI LYNN GAW

II. Dates (important events)

Enumeration Date: 05/19/2015
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 WELLPARK LN APT 4
CAMPBELLSVILLE KY
42718-4919
US

IV. Provider business mailing address

PO BOX 21890
BELFAST ME
04915-4115
US

V. Phone/Fax

Practice location:
  • Phone: 606-260-8613
  • Fax: 859-977-2683
Mailing address:
  • Phone: 502-907-0356
  • Fax: 502-919-9780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3009322
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: