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1629009790

NPI Code Detail

MEDICARE: CAROLYN R FEGENBUSH ARNP

MEDICARE: CAROLYN R FEGENBUSH ARNP

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	207QA0401X	Addiction Medicine (Family Medicine) Physician	71001579A	IN
2	363L00000X	Nurse Practitioner	71001579A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00424435	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2823492000	OTHER		PASSPORT ADVANTAGE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	50014111	OTHER		PASSPORT
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629009790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN R FEGENBUSH ARNP

Provider Business Mailing Address
First Line	:	2100 MARKET ST STE 101
Second Line	:
City	:	CHARLESTOWN
State	:	IN
Zip	:	47111-9535
Country	:	US
Telephone Number	:	812-503-5100
Fax Number	:	770-573-9513

Provider Business Practice Location Address
First Line	:	1802 E 10TH ST
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-6016
Country	:	US
Telephone Number	:	812-288-2488
Fax Number	:	770-573-9513

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	11/08/2021

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Directions to “ CAROLYN R FEGENBUSH ARNP” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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