Provider Demographics
NPI:1053854083
Name:CAREY, JAMES D (APN)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:CAREY
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37074-1304
Mailing Address - Country:US
Mailing Address - Phone:615-374-2101
Mailing Address - Fax:615-374-2609
Practice Address - Street 1:220 BROADWAY
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37074-1304
Practice Address - Country:US
Practice Address - Phone:615-374-2101
Practice Address - Fax:615-374-2609
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22001363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
22001OtherSTATE LICENSE