Provider Demographics
NPI:1114636693
Name:FARNSWORTH, CARRIE JO (FNP, PMHNP)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:JO
Last Name:FARNSWORTH
Suffix:
Gender:
Credentials:FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 BLACK HAWK RD STE 4
Mailing Address - Street 2:
Mailing Address - City:BLACK HAWK
Mailing Address - State:SD
Mailing Address - Zip Code:57718-3315
Mailing Address - Country:US
Mailing Address - Phone:605-431-3388
Mailing Address - Fax:605-403-5356
Practice Address - Street 1:8000 BLACK HAWK RD STE 4
Practice Address - Street 2:
Practice Address - City:BLACK HAWK
Practice Address - State:SD
Practice Address - Zip Code:57718-3315
Practice Address - Country:US
Practice Address - Phone:605-431-3388
Practice Address - Fax:605-403-5356
Is Sole Proprietor?:No
Enumeration Date:2022-11-23
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP002583363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily