Provider Demographics
NPI:1508990540
Name:CARR, JULIE LYNNE (CNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:LYNNE
Last Name:CARR
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 27TH ST WALLER BLDG SUITE B06
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662
Mailing Address - Country:US
Mailing Address - Phone:740-356-8008
Mailing Address - Fax:
Practice Address - Street 1:1000 ASHLAND DR STE 103
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7092
Practice Address - Country:US
Practice Address - Phone:606-324-0098
Practice Address - Fax:606-324-0315
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.15543363L00000X
KY3008468363L00000X, 363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3008468OtherKY LICENSE
OHH281901OtherMEDICARE
OHAPRN.CNP.15543OtherOH LICENSE
OH0097599Medicaid
KYK211770OtherMEDICARE
WV105923OtherWV LICENSE