Provider Demographics
NPI:1023575826
Name:CARROLL, AMY LUCILLE (RN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LUCILLE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1752
Mailing Address - Street 2:
Mailing Address - City:LAMPASAS
Mailing Address - State:TX
Mailing Address - Zip Code:76550-0040
Mailing Address - Country:US
Mailing Address - Phone:512-734-1228
Mailing Address - Fax:
Practice Address - Street 1:148 SUNFLOWER DR
Practice Address - Street 2:
Practice Address - City:LAMPASAS
Practice Address - State:TX
Practice Address - Zip Code:76550-1275
Practice Address - Country:US
Practice Address - Phone:512-734-1228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX849766163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse