MEDICARE: MS. CAROL ANN MARSHALL APRN BC PSYCH NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN123686	TN
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner		TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4048763	OTHER		BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073590147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROL ANN MARSHALL APRN BC PSYCH NP

Provider Business Mailing Address
First Line	:	219 NORTH AVE
Second Line	:	STE 201, HEALTHCARE SERVICES INC
City	:	LA FOLLETTE
State	:	TN
Zip	:	37766-2732
Country	:	US
Telephone Number	:	423-566-1314
Fax Number	:	423-566-2466

Provider Business Practice Location Address
First Line	:	219 NORTH AVE
Second Line	:	STE 201, HEALTHCARE SERVICES INC
City	:	LA FOLLETTE
State	:	TN
Zip	:	37766-2732
Country	:	US
Telephone Number	:	423-566-1314
Fax Number	:	423-566-2466

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	03/10/2008

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