Provider Demographics
NPI:1619229614
Name:ANDERSON, CAROLYN SUE (RN, PHMNP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:SUE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN, PHMNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 TABERNACLE RD
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-2526
Mailing Address - Country:US
Mailing Address - Phone:828-257-6200
Mailing Address - Fax:828-257-6268
Practice Address - Street 1:201 TABERNACLE RD
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-2526
Practice Address - Country:US
Practice Address - Phone:828-257-6200
Practice Address - Fax:828-257-6268
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC257448163W00000X
NC5005955363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner