Healthcare Provider Details

I. General information

NPI: 1801082623
Provider Name (Legal Business Name): CARRIE RHOAD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2007
Last Update Date: 09/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2181 FIESTA DR
COOKEVILLE TN
38501-4449
US

IV. Provider business mailing address

2181 FIESTA DR
COOKEVILLE TN
38501-4449
US

V. Phone/Fax

Practice location:
  • Phone: 931-265-1520
  • Fax:
Mailing address:
  • Phone: 931-265-1520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number160052
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: