Provider Demographics
NPI:1285614230
Name:MCCORMIES, CAROLYN JO (FNP)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:JO
Last Name:MCCORMIES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:CENTRAL
Mailing Address - State:AZ
Mailing Address - Zip Code:85531-0367
Mailing Address - Country:US
Mailing Address - Phone:928-428-6212
Mailing Address - Fax:
Practice Address - Street 1:2250 W 16TH ST
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-4081
Practice Address - Country:US
Practice Address - Phone:928-428-3122
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1951363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily