Healthcare Provider Details

I. General information

NPI: 1720317506
Provider Name (Legal Business Name): CAROLYN S TINSLEY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 MEDICAL CENTER DR SUITE 307
PADUCAH KY
42003-7914
US

IV. Provider business mailing address

225 MEDICAL CENTER DR SUITE 307
PADUCAH KY
42003-7914
US

V. Phone/Fax

Practice location:
  • Phone: 270-441-4700
  • Fax: 270-441-4707
Mailing address:
  • Phone: 270-441-4700
  • Fax: 270-441-4707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6037S
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: