Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 192996 | TN |
NPI | 1477196483 |
---|---|
Provider Name | Bethany Anne Carroll |
First Address | Bon Aqua, TN 37025-1445 |
Second Address | Nashville, TN 37203-1538 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2019 |
Last Update Date | 22/10/2019 |