Ciaran George Carroll, FNP, MSN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95006668 Issued in CA

Practice address

15230 Lakeshore Dr
Clearlake, CA 95422

Phone

(707) 995-2400

NPI assigned

Sep 26, 2017

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

Interoperability endpoints

• Direct secure messaging: ms_ccarro29@landmarkhealth-direct.org

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1506384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642032000000",
    "number": "1720597339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15230 LAKESHORE DR",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954228107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15230 LAKESHORE DR",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "95422",
            "telephone_number": "707-995-2400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4900 California Ave",
            "address_2": "Tower B, Ste 210B",
            "address_purpose": "LOCATION",
            "city": "Bakersfield",
            "state": "CA",
            "postal_code": "933099330",
            "country_code": "US",
            "telephone_number": "866-949-0108",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "CIARAN",
        "middle_name": "GEORGE",
        "credential": "FNP, MSN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-09-26",
        "last_updated": "2022-01-13",
        "certification_date": "2022-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95006668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brody Skylar Cameron Stenner
• Maria Guadalupe Campos
• Jessica Victoria Cardenas
• Jeffrey S Carlton, RN CRNFA
• Susan Carreon, M.S.W.
• Judith Ann Carroll, RI-C0908210706
• Melanie Irene Caruso, LVN
• Salina Lisette Castillo
• Cep America - Neurology PC
• Margaret Mary Cerbasi

• Family Nurse Practitioner in Clearlake, CA
• Providers in Clearlake, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.