Provider Demographics
NPI:1346745007
Name:CARRICO, JOHNNIE KAY (MSN FNP)
Entity Type:Individual
Prefix:
First Name:JOHNNIE
Middle Name:KAY
Last Name:CARRICO
Suffix:
Gender:F
Credentials:MSN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COLLEGE AVE RM 105
Mailing Address - Street 2:
Mailing Address - City:WISE
Mailing Address - State:VA
Mailing Address - Zip Code:24293-4400
Mailing Address - Country:US
Mailing Address - Phone:276-376-3476
Mailing Address - Fax:
Practice Address - Street 1:1 COLLEGE AVE RM 105
Practice Address - Street 2:
Practice Address - City:WISE
Practice Address - State:VA
Practice Address - Zip Code:24293-4400
Practice Address - Country:US
Practice Address - Phone:276-376-3475
Practice Address - Fax:376-328-3102
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175394363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily