Provider Demographics
NPI:1679044051
Name:CARNELL-EVANS, DEBORAH ANNETTE
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANNETTE
Last Name:CARNELL-EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:ANNETTE
Other - Last Name:CARNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1909 HAMPSHIRE PIKE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-5650
Mailing Address - Country:US
Mailing Address - Phone:931-388-5757
Mailing Address - Fax:
Practice Address - Street 1:1909 HAMPSHIRE PIKE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-5650
Practice Address - Country:US
Practice Address - Phone:931-388-5757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN144503163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health