Provider Demographics
NPI:1841961802
Name:VAN VOORST, CARLIE R (NP)
Entity type:Individual
Prefix:
First Name:CARLIE
Middle Name:R
Last Name:VAN VOORST
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1510
Mailing Address - Country:US
Mailing Address - Phone:812-868-0530
Mailing Address - Fax:812-868-2188
Practice Address - Street 1:4949 HEALTHY WAY STE A
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-1180
Practice Address - Country:US
Practice Address - Phone:812-868-0530
Practice Address - Fax:812-868-2188
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN28190361A363L00000X
IN71011749A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner