Provider Demographics
NPI:1154686954
Name:CLIFFORD-BENNETT, CARRIE L (APRN, NP-C, MSN)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:L
Last Name:CLIFFORD-BENNETT
Suffix:
Gender:F
Credentials:APRN, NP-C, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 APPLE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-8707
Mailing Address - Country:US
Mailing Address - Phone:502-542-0214
Mailing Address - Fax:
Practice Address - Street 1:100 APPLE CREEK LN
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-8707
Practice Address - Country:US
Practice Address - Phone:502-542-0214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-08
Last Update Date:2012-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007473363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health