Healthcare Provider Details

I. General information

NPI: 1790359362
Provider Name (Legal Business Name): TAMARA SUE CARDER CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 COMMERCE DR
ELIZABETHTOWN KY
42701-1281
US

IV. Provider business mailing address

300 HOPE ST
MT WASHINGTON KY
40047-7757
US

V. Phone/Fax

Practice location:
  • Phone: 270-506-1064
  • Fax:
Mailing address:
  • Phone: 502-538-1000
  • Fax: 502-538-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: