Provider Demographics
NPI:1477601474
Name:MCLENNAN, CAROL SUE (MSN, ARNP, CNS, FNP)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:SUE
Last Name:MCLENNAN
Suffix:
Gender:F
Credentials:MSN, ARNP, CNS, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 HARDWOOD FORREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:LOUSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214
Mailing Address - Country:US
Mailing Address - Phone:502-419-3794
Mailing Address - Fax:
Practice Address - Street 1:3505 HARDWOOD FOREST DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-6513
Practice Address - Country:US
Practice Address - Phone:502-419-3794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1050157163W00000X
KY2757S363LP0808X
KY2757P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health