Provider Demographics
NPI:1588438881
Name:GREER, CARLIE DEEANN (APRN)
Entity type:Individual
Prefix:
First Name:CARLIE
Middle Name:DEEANN
Last Name:GREER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CARLIE
Other - Middle Name:DEEANN
Other - Last Name:FOSSITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2048 MCCLURE BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LILY
Mailing Address - State:KY
Mailing Address - Zip Code:40740-3455
Mailing Address - Country:US
Mailing Address - Phone:859-588-8659
Mailing Address - Fax:
Practice Address - Street 1:195 COMMERCIAL DR STE 98
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40744-5200
Practice Address - Country:US
Practice Address - Phone:606-878-1219
Practice Address - Fax:606-877-1195
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4011315363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily