Provider Demographics
NPI:1285943605
Name:CARSON, JOHN GLEN (NP-C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:GLEN
Last Name:CARSON
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5304 CANE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-3839
Mailing Address - Country:US
Mailing Address - Phone:615-846-4545
Mailing Address - Fax:615-717-6239
Practice Address - Street 1:5304 CANE RIDGE RD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-3839
Practice Address - Country:US
Practice Address - Phone:615-846-4545
Practice Address - Fax:615-717-6239
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15232363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily