Provider Demographics
NPI:1063486041
Name:LAMAR, CAROLYN FAYE (ANP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:FAYE
Last Name:LAMAR
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8120 S CULLEN PL
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-9734
Mailing Address - Country:US
Mailing Address - Phone:812-236-3189
Mailing Address - Fax:
Practice Address - Street 1:123 N MCCREARY ST
Practice Address - Street 2:
Practice Address - City:FORT BRANCH
Practice Address - State:IN
Practice Address - Zip Code:47648-1313
Practice Address - Country:US
Practice Address - Phone:812-753-1039
Practice Address - Fax:812-753-1122
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002084A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health