Provider Demographics
NPI:1497784136
Name:LINGERFELT, CARRIE N (FNP/ CNM)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:N
Last Name:LINGERFELT
Suffix:
Gender:F
Credentials:FNP/ CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 EDWARDS CT
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-3137
Mailing Address - Country:US
Mailing Address - Phone:423-943-5351
Mailing Address - Fax:
Practice Address - Street 1:2151 CENTURY LN
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-4469
Practice Address - Country:US
Practice Address - Phone:423-926-2500
Practice Address - Fax:423-926-5999
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10848363LF0000X
TNAPN10848363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN100048934OtherPHP
TN4104130OtherBLUECROSSBLUESHIELD
TN3640359Medicaid
TNTN01M9OtherJOHN DEERE
TN3640359Medicare Oscar/Certification
TN3640359Medicare PIN
TNTN01M9OtherJOHN DEERE
TN3640359Medicare PIN