Provider Demographics
NPI:1073590147
Name:MARSHALL, CAROL ANN (APRN BC PSYCH NP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:APRN BC PSYCH NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 NORTH AVE
Mailing Address - Street 2:STE 201, HEALTHCARE SERVICES INC
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-2732
Mailing Address - Country:US
Mailing Address - Phone:423-566-1314
Mailing Address - Fax:423-566-2466
Practice Address - Street 1:219 NORTH AVE
Practice Address - Street 2:STE 201, HEALTHCARE SERVICES INC
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-2732
Practice Address - Country:US
Practice Address - Phone:423-566-1314
Practice Address - Fax:423-566-2466
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN123686363LP0808X
TN363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
4048763OtherBLUE CROSS BLUE SHIELD
TN3907212Medicaid
P68660Medicare UPIN
TN3907212Medicaid
TN3908004Medicare PIN
4048763OtherBLUE CROSS BLUE SHIELD