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General NPI Number Information
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NPI Number | 1376118158
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Entity Type | Individual
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Provider Name | CARRIE ANN GRESHAM NP
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Gender | Female
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Dates
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Enumeration Date | 05/24/2021
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 1100 WALNUT ST
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City | OWENSBORO
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State | KY
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Zip | 42301-2956
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Country | US
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Telephone | 270-689-6500
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Fax | 270-689-6677
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Provider Business Mailing Address
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Address Line | PO BOX 1230
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City | EVANSVILLE
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State | IN
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Zip | 47706-1230
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Country | US
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Telephone | 812-476-7200
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Fax | 812-471-4514
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 28190743A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 71011434A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4006013
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License Number State | KY
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