Provider Demographics
NPI:1770173007
Name:BEARDSLEY, CAROLINA ISABEL (NP)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:ISABEL
Last Name:BEARDSLEY
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 1:576 FORT LOUDOUN MEDICAL CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-5676
Mailing Address - Country:US
Mailing Address - Phone:865-271-6180
Mailing Address - Fax:
Practice Address - Street 1:576 FORT LOUDOUN MEDICAL CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-5676
Practice Address - Country:US
Practice Address - Phone:865-271-6180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29036363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ074828Medicaid