Provider Demographics
NPI:1891935482
Name:BADDELEY, CAROLYN G (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:G
Last Name:BADDELEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3170 MEBANE RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:TN
Mailing Address - Zip Code:38060-4012
Mailing Address - Country:US
Mailing Address - Phone:901-465-7293
Mailing Address - Fax:
Practice Address - Street 1:3170 MEBANE RD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:TN
Practice Address - Zip Code:38060-4012
Practice Address - Country:US
Practice Address - Phone:901-465-7293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN079819367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered