Provider Demographics
NPI:1689748527
Name:CARMICHAEL, ELIZABETH KATHLEEN (MSN, FNP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:KATHLEEN
Last Name:CARMICHAEL
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 FAIRWAY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-2628
Mailing Address - Country:US
Mailing Address - Phone:757-642-7926
Mailing Address - Fax:
Practice Address - Street 1:32 PHYSICIAN DR
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-8486
Practice Address - Country:US
Practice Address - Phone:828-564-9222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166648363LF0000X
NC5004639363LF0000X
VA0001136005163W00000X
NC101983163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
11782223OtherCAQH
NC7004235Medicaid