Provider Demographics
NPI:1699220194
Name:KAMP, CARRIE JO (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:JO
Last Name:KAMP
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9111 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7429
Mailing Address - Country:US
Mailing Address - Phone:219-398-8165
Mailing Address - Fax:
Practice Address - Street 1:8645 CONNECTICUT ST
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6222
Practice Address - Country:US
Practice Address - Phone:219-769-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2019-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71007357A363LF0000X
IL209014712363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily