Healthcare Provider Details

I. General information

NPI: 1922666361
Provider Name (Legal Business Name): MARIA NICOLE CARR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2019
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4331 CHURCHMAN AVE STE 101
LOUISVILLE KY
40215-1164
US

IV. Provider business mailing address

PO BOX 909
LOUISVILLE KY
40201-0909
US

V. Phone/Fax

Practice location:
  • Phone: 502-977-5907
  • Fax:
Mailing address:
  • Phone: 502-977-5907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberMW010533
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4011311
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: