Provider Demographics
NPI:1770035362
Name:PLUNKETT, CARLENA (NP)
Entity Type:Individual
Prefix:
First Name:CARLENA
Middle Name:
Last Name:PLUNKETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 CARVER RD
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-3937
Mailing Address - Country:US
Mailing Address - Phone:770-227-9222
Mailing Address - Fax:478-254-6093
Practice Address - Street 1:625 CARVER RD
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-3937
Practice Address - Country:US
Practice Address - Phone:770-227-9222
Practice Address - Fax:478-254-6093
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-29
Last Update Date:2016-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN201146363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily