Provider Demographics
NPI:1124748165
Name:CUNNINGHAM, CARLA BERNICE
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:BERNICE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 SHUTE LN
Mailing Address - Street 2:
Mailing Address - City:OLD HICKORY
Mailing Address - State:TN
Mailing Address - Zip Code:37138-2139
Mailing Address - Country:US
Mailing Address - Phone:615-415-8114
Mailing Address - Fax:
Practice Address - Street 1:225 SHUTE LN
Practice Address - Street 2:
Practice Address - City:OLD HICKORY
Practice Address - State:TN
Practice Address - Zip Code:37138-2139
Practice Address - Country:US
Practice Address - Phone:615-415-8114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider