Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | PE1528 | TN |
NPI | 1184751984 |
---|---|
Provider Name | Ladonna Selby Carey |
First Address | Kingsport, TN 37664-3163 |
Second Address | Kingsport, TN 37664-3163 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 08/07/2007 |