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General NPI Number Information
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NPI Number | 1972180545
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Entity Type | Individual
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Provider Name | MICHELLE CARMEN CARLO
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Gender | Female
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Dates
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Enumeration Date | 03/28/2021
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Last Update Date | 08/31/2021
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Provider Practice Location Address
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Address Line | 2195 HARRODSBURG RD FL 1
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City | LEXINGTON
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State | KY
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Zip | 40504-3516
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Country | US
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Telephone | 859-323-2356
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Fax | 859-323-5799
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Provider Business Mailing Address
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Address Line | 2195 HARRODSBURG RD FL 1
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City | LEXINGTON
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State | KY
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Zip | 40504-3516
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Country | US
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Telephone | 859-323-2356
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Fax | 859-323-5799
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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 | 3015938
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License Number State | KY
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