Healthcare Provider Details

I. General information

NPI: 1699957423
Provider Name (Legal Business Name): CARLA WRIGHT MCCREERY LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 RANSOM PL
NASHVILLE TN
37217-3841
US

IV. Provider business mailing address

229 PORTLAND RD
WHITE HOUSE TN
37188-7908
US

V. Phone/Fax

Practice location:
  • Phone: 615-279-6700
  • Fax:
Mailing address:
  • Phone: 615-285-0384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number66421
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: