Provider Demographics
NPI:1063386613
Name:MCCOLL, CARRIE LYNN (RN)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYNN
Last Name:MCCOLL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP
Mailing Address - Street 1:10025 NEBO RD
Mailing Address - Street 2:
Mailing Address - City:NEBO
Mailing Address - State:KY
Mailing Address - Zip Code:42441-9745
Mailing Address - Country:US
Mailing Address - Phone:270-621-0101
Mailing Address - Fax:
Practice Address - Street 1:10025 NEBO RD
Practice Address - Street 2:
Practice Address - City:NEBO
Practice Address - State:KY
Practice Address - Zip Code:42441-9745
Practice Address - Country:US
Practice Address - Phone:270-621-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY65956051223P0300X
KY1160938163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No1223P0300XDental ProvidersDentistPeriodontics