Provider Demographics
NPI:1487026761
Name:NORTON, CAROLYN MICHELE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MICHELE
Last Name:NORTON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1743 SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-0927
Mailing Address - Country:US
Mailing Address - Phone:928-757-8111
Mailing Address - Fax:928-757-3256
Practice Address - Street 1:2580 HWAY 95
Practice Address - Street 2:SUITE 209
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7491
Practice Address - Country:US
Practice Address - Phone:928-758-5905
Practice Address - Fax:928-758-1458
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18769363LP0808X
AZAP10078363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health