Provider Demographics
NPI:1104552397
Name:KNOLL, CAROLYN ELIZABETH (APRN)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:ELIZABETH
Last Name:KNOLL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 SQUIRES RD APT 7202
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-5747
Mailing Address - Country:US
Mailing Address - Phone:185-994-0943
Mailing Address - Fax:
Practice Address - Street 1:166 PASADENA DR STE 100
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2974
Practice Address - Country:US
Practice Address - Phone:859-278-0319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3018131363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine