Provider Demographics
NPI:1457490336
Name:CARPENTER, KATHY LORAINE (RN)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:LORAINE
Last Name:CARPENTER
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 1:428 CANEY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37857-7645
Mailing Address - Country:US
Mailing Address - Phone:423-272-3050
Mailing Address - Fax:
Practice Address - Street 1:201 PARK BLVD
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857-2919
Practice Address - Country:US
Practice Address - Phone:423-272-7641
Practice Address - Fax:423-921-8073
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000074075163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health