Provider Demographics
NPI:1972860930
Name:CARRENARD-MCDOWELL, SHIRLEY (FNP, PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:
Last Name:CARRENARD-MCDOWELL
Suffix:
Gender:F
Credentials:FNP, PMHNP
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:
Other - Last Name:CARRENARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP, FNP
Mailing Address - Street 1:801 SUMMIT AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-7813
Mailing Address - Country:US
Mailing Address - Phone:336-907-4345
Mailing Address - Fax:
Practice Address - Street 1:300 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3816
Practice Address - Country:US
Practice Address - Phone:516-823-8855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-16
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009070363LP0808X
NY336942363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty