Provider Demographics
NPI:1720313182
Name:CARTER WAY, JOELY A (FNP-BC)
Entity type:Individual
Prefix:
First Name:JOELY
Middle Name:A
Last Name:CARTER WAY
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 1:401 PRINCETON RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2028
Mailing Address - Country:US
Mailing Address - Phone:423-854-5880
Mailing Address - Fax:423-854-5685
Practice Address - Street 1:401 PRINCETON RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2028
Practice Address - Country:US
Practice Address - Phone:423-854-5880
Practice Address - Fax:423-854-5685
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000014307363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1035I00015Medicare PIN