MEDICARE: CAROLYN ELIZABETH KALLMEYER APRN

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	363LF0000X	Family Nurse Practitioner	3004450	KY
2	364SF0001X	Family Health Clinical Nurse Specialist	3004450	KY

General Provider Information

NPI Number	:	1265734370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN ELIZABETH KALLMEYER APRN

Provider Business Mailing Address
First Line	:	2620 ELM HILL PIKE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37214-3108
Country	:	US
Telephone Number	:	615-425-4211
Fax Number	:	615-425-4201

Provider Business Practice Location Address
First Line	:	2150 DIXIE HWY
Second Line	:
City	:	FT MITCHELL
State	:	KY
Zip	:	41017-2902
Country	:	US
Telephone Number	:	859-292-1784
Fax Number	:	859-292-1785

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

Provider Enumeration Date	:	11/22/2010
Last Update Date	:	06/17/2015

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