Provider Demographics
NPI:1043230154
Name:CARNEY, CAROL ANN (CNP)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:CARNEY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 N MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1301
Mailing Address - Country:US
Mailing Address - Phone:517-879-1007
Mailing Address - Fax:888-828-8679
Practice Address - Street 1:142 N MECHANIC ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1301
Practice Address - Country:US
Practice Address - Phone:517-879-1007
Practice Address - Fax:888-828-8679
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI470155202363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8320027OtherPHYSICIANS HEALTH PLAN