Provider Demographics
NPI:1972069722
Name:CARROLL, COURTNEY (FNP-C)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 PAPERMILL POINTE WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1903
Mailing Address - Country:US
Mailing Address - Phone:865-673-5000
Mailing Address - Fax:865-330-6323
Practice Address - Street 1:2103 FOREST DR STE 5
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:TN
Practice Address - Zip Code:37615-8423
Practice Address - Country:US
Practice Address - Phone:423-794-3142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25120363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ046854Medicaid