Provider Demographics
NPI:1497419626
Name:HENDRICKS, CARLY ANN (APRN)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:ANN
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:553-636-4432
Mailing Address - Fax:
Practice Address - Street 1:3333 BURNET AVE, ML 11027
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-517-2234
Practice Address - Fax:513-803-1969
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0035261363L00000X
OH529290163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse