Provider Demographics
NPI:1124215322
Name:TESTERMAN, CARLA S (RN)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:S
Last Name:TESTERMAN
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 1:101 SATANTA RD
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-4259
Mailing Address - Country:US
Mailing Address - Phone:423-323-5074
Mailing Address - Fax:
Practice Address - Street 1:1651 BLOUNTVILLE BLVD
Practice Address - Street 2:
Practice Address - City:BLOUNTVILLE
Practice Address - State:TN
Practice Address - Zip Code:37617-4708
Practice Address - Country:US
Practice Address - Phone:423-354-1600
Practice Address - Fax:423-354-1606
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000036390163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse