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General NPI Number Information
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NPI Number | 1922074178
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Entity Type | Individual
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Provider Name | BETTY GWEN CARLTON FNP
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Gender | Female
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Dates
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Enumeration Date | 02/27/2006
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Last Update Date | 12/18/2009
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Provider Practice Location Address
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Address Line | 1350 MACKEY BRANCH DR STE 114
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City | CHATTANOOGA
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State | TN
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Zip | 37421-3483
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Country | US
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Telephone | 423-468-3267
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Fax | 423-468-3270
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Provider Business Mailing Address
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Address Line | 1350 MACKEY BRANCH DR STE 114
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City | CHATTANOOGA
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State | TN
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Zip | 37421-3483
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Country | US
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Telephone | 423-468-3267
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Fax | 423-468-3270
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN5668
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN55779
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License Number State | TN
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