Provider Demographics
NPI:1801514922
Name:CLOUGH, CARRIE MAE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:MAE
Last Name:CLOUGH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1248 FORT BRAGG RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-4981
Mailing Address - Country:US
Mailing Address - Phone:910-323-0334
Mailing Address - Fax:910-676-7340
Practice Address - Street 1:1248 FORT BRAGG RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-4981
Practice Address - Country:US
Practice Address - Phone:910-323-0334
Practice Address - Fax:910-676-7340
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5016749363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily