Provider Demographics
NPI:1417656554
Name:MCCARROLL, CHELSY MARIE (FNP-BC)
Entity type:Individual
Prefix:
First Name:CHELSY
Middle Name:MARIE
Last Name:MCCARROLL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 CHEROKEE TRL
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-7112
Mailing Address - Country:US
Mailing Address - Phone:931-980-5915
Mailing Address - Fax:
Practice Address - Street 1:2147 WILMA RUDOLPH BLVD STE 102
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-6798
Practice Address - Country:US
Practice Address - Phone:931-241-4115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33514363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily