MEDICARE: CARLA M. CREEKMORE C.R.N.P

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	363LP0200X	Pediatric Nurse Practitioner	R139268	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922058643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA M. CREEKMORE C.R.N.P

Provider Business Mailing Address
First Line	:	500 GREENE ST
Second Line	:	CHILDREN'S MEDICAL GROUP
City	:	CUMBERLAND
State	:	MD
Zip	:	21502-2755
Country	:	US
Telephone Number	:	301-724-7616
Fax Number	:	301-724-4811

Provider Business Practice Location Address
First Line	:	5211 COMMERCE CROSSINGS DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40229-2183
Country	:	US
Telephone Number	:	502-966-3918
Fax Number	:	502-969-3665

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	10/13/2020

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