Provider Demographics
NPI:1508245960
Name:CARNEY, JODI LYNN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:LYNN
Last Name:CARNEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:LYNN
Other - Last Name:GAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 21890
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4115
Mailing Address - Country:US
Mailing Address - Phone:502-907-0356
Mailing Address - Fax:502-919-9780
Practice Address - Street 1:1107 CROWN POINTE DR STE 107
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7280
Practice Address - Country:US
Practice Address - Phone:270-506-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-19
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009322363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
000001238545OtherANTHEM PIN
KY1795296OtherWELLCARE OF KY PROVIDER ID NUMBER
6339064OtherAETNA PROVIDER ID
6996270OtherUNITED HEALTHCARE PROVIDER ID NUMBER
CS1923400296OtherCARESOURCE PROVIDER ID NUMBER
00202826OtherSIHO PROVIDER ID NUMBER
IN300022004Medicaid
KY7100348570Medicaid
KY336358KYIPOtherAETNA BETTER HEALTH OF KY PROVIDER ID NUMBER