Provider Demographics
NPI:1780678763
Name:NETT, CARRILEA REED (MD)
Entity Type:Individual
Prefix:
First Name:CARRILEA
Middle Name:REED
Last Name:NETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-272-5395
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:4915 NORTON HEALTHCARE BLVD STE 203
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2861
Practice Address - Country:US
Practice Address - Phone:502-423-9595
Practice Address - Fax:502-719-0161
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38809207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50005048OtherPASSPORT
KY000057120MOtherHUMANA - WS
KY127026OtherSIHO - WS
KY65925109OtherMEDICAID GRP
KY1147806OtherCIGNA-WS
KYNE64083835Medicaid
KY000000724267OtherANTHEM - WS
IN201040580Medicaid
KY64083835Medicaid
KY50034481OtherPASSPORT - WS
KY5581OtherMEDICARE GRP
KY64083835Medicaid
IN201040580Medicaid
1558107Medicare PIN