Provider Demographics
NPI:1275581662
Name:CARROLL, SHEILA ANN (NP)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:ANN
Last Name:CARROLL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 MADISON AVENUE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41014
Mailing Address - Country:US
Mailing Address - Phone:859-261-0323
Mailing Address - Fax:859-261-0464
Practice Address - Street 1:2020 MADISON AVE.
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41012
Practice Address - Country:US
Practice Address - Phone:859-261-0323
Practice Address - Fax:859-261-0464
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002141363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0061011Medicaid
S10241Medicare UPIN
OH0061011Medicaid