Healthcare Provider Details

I. General information

NPI: 1578038386
Provider Name (Legal Business Name): CAREY MADISON WALTER DNP, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAREY M HOLMES

II. Dates (important events)

Enumeration Date: 10/08/2018
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7565 DANNAHER DR
POWELL TN
37849-4029
US

IV. Provider business mailing address

462 AXUM RD
WILLOW SPRING NC
27592-9172
US

V. Phone/Fax

Practice location:
  • Phone: 865-859-8000
  • Fax:
Mailing address:
  • Phone: 336-339-3008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number246655
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number32119
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: