Provider Demographics
NPI:1891186631
Name:CARR, CORY (NP)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:CARR
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 1:1621 W MORRIS BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-2969
Mailing Address - Country:US
Mailing Address - Phone:423-317-7412
Mailing Address - Fax:423-317-7415
Practice Address - Street 1:1621 W MORRIS BLVD STE C
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-2969
Practice Address - Country:US
Practice Address - Phone:423-317-7412
Practice Address - Fax:423-317-7415
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000019620363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0000019620OtherLICENSE