Provider Demographics
NPI:1316977275
Name:SWEAT, CAROLE R (APRN, MSN)
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:R
Last Name:SWEAT
Suffix:
Gender:F
Credentials:APRN, MSN
Other - Prefix:
Other - First Name:CAROLE
Other - Middle Name:R
Other - Last Name:BOUDREAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:9880 ANGIES WAY
Practice Address - Street 2:SUTIE 350
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2851
Practice Address - Country:US
Practice Address - Phone:502-423-9595
Practice Address - Fax:502-719-0161
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1068394363LW0102X
KY3004402363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200876590Medicaid
50011024OtherPASSPORT SPECIALITY
50011025OtherPASSPORT SPECIALIST
KY50034508OtherPASSPORT (WSP)
KYK028570OtherMEDICARE PTAN (WSP)
000000535084OtherANTHEM
KY3946879OtherCIGNA (WSP)
KY7801436200Medicaid
000000536025OtherANTHEM
KY000000732544OtherANTHEM (WSP)
KY000057121YOtherHUMANA (WSP)
KY128620OtherSIHO - KCPAG
KY128620OtherSIHO (WSP)
50011023OtherPASSPORT PCP
KY000057121YOtherHUMANA (WSP)
KY128620OtherSIHO - KCPAG