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NPI Code Detail

MEDICARE: MS. KELLY A. CARLSON APN

MEDICARE:  MS. KELLY A. CARLSON  APN
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner13956TN

General Provider Information

NPI Number : 1548402654
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KELLY A. CARLSON APN
Provider Business Mailing Address
First Line : 423 MEDICAL PARK DR STE 200
Second Line :
City : LENOIR CITY
State : TN
Zip : 37772-5641
Country : US
Telephone Number : 865-970-9800
Fax Number :
Provider Business Practice Location Address
First Line : 2347 JONES BEND RD
Second Line : PENINSULA HOSPITAL
City : LOUISVILLE
State : TN
Zip : 37777-5213
Country : US
Telephone Number : 865-970-9800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2009
Last Update Date : 04/19/2011

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Directions to “ MS. KELLY A. CARLSON APN” Practice Location

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