Provider Demographics
NPI:1154322154
Name:CARMAN, MARY D (ARNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:D
Last Name:CARMAN
Suffix:
Gender:F
Credentials:ARNP
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 277
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:KY
Mailing Address - Zip Code:40347-0277
Mailing Address - Country:US
Mailing Address - Phone:859-846-4445
Mailing Address - Fax:859-846-4761
Practice Address - Street 1:129 S WINTER ST
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:KY
Practice Address - Zip Code:40347-1015
Practice Address - Country:US
Practice Address - Phone:859-846-4445
Practice Address - Fax:859-846-4761
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3277P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78004876Medicaid
P20695Medicare UPIN
KY78004876Medicaid