Provider Demographics
NPI:1639104268
Name:MEDLEY, CAROL LYNNE (FNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:CAROL
Middle Name:LYNNE
Last Name:MEDLEY
Suffix:
Gender:F
Credentials:FNP-BC
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Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:353 NEW SHACKLE ISLAND ROAD
Mailing Address - Street 2:SUITE 140 C
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3181
Mailing Address - Country:US
Mailing Address - Phone:615-826-5664
Mailing Address - Fax:615-826-5665
Practice Address - Street 1:353 NEW SHACKLE ISLAND ROAD
Practice Address - Street 2:SUITE 140 C
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3181
Practice Address - Country:US
Practice Address - Phone:615-826-5664
Practice Address - Fax:615-826-5665
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN 6776363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3736791OtherMEDICARE PTAN
TNP80893Medicare UPIN
TN3736791Medicare PIN