Provider Demographics
NPI:1992877823
Name:LEDBETTER, CAROL ANN (APRN, BC)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:LEDBETTER
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 15TH ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-2835
Mailing Address - Country:US
Mailing Address - Phone:541-962-3050
Mailing Address - Fax:541-962-3008
Practice Address - Street 1:142 E. DEARBORN
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:OR
Practice Address - Zip Code:97883
Practice Address - Country:US
Practice Address - Phone:541-562-6062
Practice Address - Fax:541-562-5757
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily