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NPI Code Detail

MEDICARE: KERRY CARROLL NP

MEDICARE: KERRY CARROLL 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
1363LG0600XGerontology Nurse Practitioner810971TX
2363LP0808XPsychiatric/Mental Health Nurse PractitionerAP61078096WA

General Provider Information

NPI Number : 1871027904
Entity Type Code : Individual
Provider Name (Legal Business Name) : KERRY CARROLL NP
Provider Business Mailing Address
First Line : 3285 FERGUSON ST SW
Second Line :
City : TUMWATER
State : WA
Zip : 98512-6143
Country : US
Telephone Number : 360-943-1907
Fax Number : 360-943-1907
Provider Business Practice Location Address
First Line : 3285 FERGUSON ST SW
Second Line :
City : TUMWATER
State : WA
Zip : 98512-6143
Country : US
Telephone Number : 360-943-1907
Fax Number : 603-943-1932
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2017
Last Update Date : 04/07/2022

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Directions to “ KERRY CARROLL NP” Practice Location

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