Healthcare Provider Details

I. General information

NPI: 1104552397
Provider Name (Legal Business Name): CAROLYN ELIZABETH KNOLL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 PASADENA DR STE 100
LEXINGTON KY
40503-2974
US

IV. Provider business mailing address

440 SQUIRES RD APT 7202
LEXINGTON KY
40515-5747
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-0319
  • Fax:
Mailing address:
  • Phone: 185-994-0943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number3018131
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: