=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982957536
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY JEAN CARROLL RN, CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2012
-----------------------------------------------------
Last Update Date | 06/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1415 TOWN SQUARE LN
-----------------------------------------------------
City | FARIBAULT
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55021-6088
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-323-8100
-----------------------------------------------------
Fax | 833-974-2090
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 731
-----------------------------------------------------
City | NORTHFIELD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55057-0731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-412-0676
-----------------------------------------------------
Fax | 507-332-4003
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | R 189067-5
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------