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NPI Code Detail

MEDICARE: KACIE D CARROLL

MEDICARE: KACIE D CARROLL
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
1101YM0800XMental Health Counselor
2171M00000XCase Manager/Care Coordinator
3101YM0800XMental Health CounselorP2207005AR

General Provider Information

NPI Number : 1811258809
Entity Type Code : Individual
Provider Name (Legal Business Name) : KACIE D CARROLL
Provider Business Mailing Address
First Line : PO BOX 23070
Second Line :
City : BARLING
State : AR
Zip : 72923-0070
Country : US
Telephone Number : 479-452-5040
Fax Number : 479-452-5047
Provider Business Practice Location Address
First Line : 7217 CAMERON PARK DR
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-6167
Country : US
Telephone Number : 479-831-6007
Fax Number : 479-782-1242
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2012
Last Update Date : 02/19/2025

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Directions to “ KACIE D CARROLL ” Practice Location

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