Carolyn R Fegenbush
Nurse Practitioner Family Doctor - Addiction Medicine
1802 E 10th St
Jeffersonville
, Indiana 47130-6016
Carolyn R Fegenbush
Nurse Practitioner Family Doctor - Addiction Medicine
1802 E 10th St
Jeffersonville
, Indiana 47130-6016
(770) 573-9513
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About
Features
Specialties
- Family Doctor - Addiction Medicine
- Nurse Practitioner
Languages spoken
- English
Location
First Address
- Carolyn R Fegenbush
- 2100 Market St Ste 101
- Charlestown, IN
- Zip : 47111-9535
- Fax : (770) 573-9513
- Phone : (812) 503-5100
Second Address
- Carolyn R Fegenbush
- 1802 E 10th St
- Jeffersonville, IN
- Zip : 47130-6016
- Fax : (770) 573-9513
- Phone : (812) 288-2488
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Is Carolyn R Fegenbush a sole practitioner?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 207QA0401X | Family Doctor - Addiction Medicine | 71001579A | IN |
| Y | 363L00000X | Nurse Practitioner | 71001579A | IN |
National Provider Identifier
| NPI | 1629009790 |
|---|---|
| Provider Name | Carolyn R Fegenbush |
| First Address | Charlestown, IN 47111-9535 |
| Second Address | Jeffersonville, IN 47130-6016 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 06/07/2006 |
| Last Update Date | 08/11/2021 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 200451720 | (05) | IN |
| 2823492000 | PASSPORT ADVANTAGE (01) | |
| 50014111 | PASSPORT (01) | |
| 78010824 | (05) | KY |
| P00424435 | RAILROAD MEDICARE (01) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.