Provider Demographics
NPI:1164192209
Name:CASSEDY, CAROL LYNN (DNP, APRN)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:LYNN
Last Name:CASSEDY
Suffix:
Gender:F
Credentials:DNP, APRN
Other - Prefix:DR
Other - First Name:CAROL
Other - Middle Name:LYNN
Other - Last Name:CASSEDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:720 COOL SPRINGS BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7259
Mailing Address - Country:US
Mailing Address - Phone:480-261-2005
Mailing Address - Fax:
Practice Address - Street 1:4418 MALCOLM AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1122
Practice Address - Country:US
Practice Address - Phone:480-261-2005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1140860103T00000X
KY3014760363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist