Provider Demographics
NPI:1689648487
Name:CARNES, MICHELLE HOPKINS (ANP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:HOPKINS
Last Name:CARNES
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:887 CONGRESS ST STE 400
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3163
Mailing Address - Country:US
Mailing Address - Phone:207-774-6368
Mailing Address - Fax:207-774-9388
Practice Address - Street 1:887 CONGRESS ST STE 400
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3163
Practice Address - Country:US
Practice Address - Phone:207-774-6368
Practice Address - Fax:207-774-9388
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1929363LW0102X
MERN098519163WR0006X
MECNP251471363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q15983Medicare UPIN
80784Medicare ID - Type Unspecified