Provider Demographics
NPI:1649425745
Name:CARR, MISTY MARIE (ARNP)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:MARIE
Last Name:CARR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:MARIE
Other - Last Name:HENSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1805 N EWING ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-1126
Mailing Address - Country:US
Mailing Address - Phone:812-569-3006
Mailing Address - Fax:812-569-3006
Practice Address - Street 1:720 W BROADWAY STE 201
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3245
Practice Address - Country:US
Practice Address - Phone:502-893-5502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9190978363L00000X
IN71003274A363LF0000X
KY3008211363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily