Provider Demographics
NPI:1912247644
Name:KING, CARRIE YVONNE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:YVONNE
Last Name:KING
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:3903 VANTAGE PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-6801
Mailing Address - Country:US
Mailing Address - Phone:502-356-4377
Mailing Address - Fax:888-959-2460
Practice Address - Street 1:3903 VANTAGE PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-6801
Practice Address - Country:US
Practice Address - Phone:502-356-4377
Practice Address - Fax:888-959-2460
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-16
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3007860363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner