Provider Demographics
NPI:1497144968
Name:MCCULLAH, CARA JEAN (RN, MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:JEAN
Last Name:MCCULLAH
Suffix:
Gender:F
Credentials:RN, MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 SHARP CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-6112
Mailing Address - Country:US
Mailing Address - Phone:865-617-1045
Mailing Address - Fax:
Practice Address - Street 1:2702 JACKSBORO PIKE
Practice Address - Street 2:
Practice Address - City:JACKSBORO
Practice Address - State:TN
Practice Address - Zip Code:37757-4850
Practice Address - Country:US
Practice Address - Phone:423-201-9937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19236363LF0000X
KY3009180363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily