Provider Demographics
NPI:1952011843
Name:CROSS, CARRIE JO (RN)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:JO
Last Name:CROSS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 TELETECH DR STE 1
Mailing Address - Street 2:
Mailing Address - City:MOUNDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26041-2790
Mailing Address - Country:US
Mailing Address - Phone:304-843-3379
Mailing Address - Fax:
Practice Address - Street 1:100 TELETECH DR STE 1
Practice Address - Street 2:
Practice Address - City:MOUNDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26041-2790
Practice Address - Country:US
Practice Address - Phone:304-843-3379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV87789163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health