Provider Demographics
NPI:1649554064
Name:ERNST, CARLY SUZANNE (NP-C)
Entity type:Individual
Prefix:MS
First Name:CARLY
Middle Name:SUZANNE
Last Name:ERNST
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:333 COMMERCE ST
Mailing Address - Street 2:SUITE 360
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37201-1826
Mailing Address - Country:US
Mailing Address - Phone:615-913-5086
Mailing Address - Fax:888-494-2588
Practice Address - Street 1:301 MAIN ST STE 2200
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70801-0014
Practice Address - Country:US
Practice Address - Phone:225-442-3597
Practice Address - Fax:855-737-5542
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2018-12-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXAP120012363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX366146401Medicaid