Provider Demographics
NPI:1811635212
Name:METZ, CARLY (APRN)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:METZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ROSE ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-7001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:KY CHILDREN'S HOSPITAL 800 ROSE ST 4TH FLOOR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-7001
Practice Address - Country:US
Practice Address - Phone:859-218-0921
Practice Address - Fax:859-257-1831
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY3017992363LP0222X
KY1144366163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No163WP0200XNursing Service ProvidersRegistered NursePediatrics