Healthcare Provider Details

I. General information

NPI: 1891186631
Provider Name (Legal Business Name): CORY CARR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2015
Last Update Date: 02/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 W MORRIS BLVD STE C
MORRISTOWN TN
37813-2969
US

IV. Provider business mailing address

1621 W MORRIS BLVD STE C
MORRISTOWN TN
37813-2969
US

V. Phone/Fax

Practice location:
  • Phone: 423-317-7412
  • Fax: 423-317-7415
Mailing address:
  • Phone: 423-317-7412
  • Fax: 423-317-7415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0000019620
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: