Healthcare Provider Details

I. General information

NPI: 1649425745
Provider Name (Legal Business Name): MISTY MARIE CARR ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISTY MARIE HENSLEY NP

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 11/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W BROADWAY STE 201
LOUISVILLE KY
40202-3245
US

IV. Provider business mailing address

1805 N EWING ST
SEYMOUR IN
47274-1126
US

V. Phone/Fax

Practice location:
  • Phone: 502-893-5502
  • Fax:
Mailing address:
  • Phone: 812-569-3006
  • Fax: 812-569-3006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9190978
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71003274A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number3008211
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: