Courtney Carroll, FNP-C
Individual provider Active NPI Family Nurse Practitioner · Gray, TN
NPI 1972069722 · NPPES record last updated Apr 2, 2020
Key facts
- NPI
- 1972069722
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 25120 (TN)
- Practice address
- 2103 Forest Dr Ste 5
Gray, TN 37615-8423 - Phone
- (423) 794-3142
- NPI assigned
- Feb 18, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- East Tennessee State University Quillen College of Medicine, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Arthritis Associates of Kingsport, PLLC
Practice addresses (Care Compare)
3 Sheridan SQ
Kingsport, TN 37660-7390
Phone (423) 392-6840
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190327003169 | TN | Practitioner - Nurse Practitioner | 3072853142 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Arthritis Associates of Kingsport, PLLC | Current |
Accepting new patients | |
| The Beauty Studio Medical Aesthetics | Current | Accepting new patients |
Locations
3 Sheridan Sq
Kingsport, TN 37660
Phone (423) 392-6840
Interoperability endpoints
- courtney.carroll@aps.directbygreenway.com
- courtney.carroll.p1@direct.aak.nextgenshare.com
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 25120 | TN | Yes |
Addresses
Primary practice location
2103 Forest Dr Ste 5
Gray, TN 37615-8423
Mailing address
1326 Papermill Pointe Way
Knoxville, TN 37909-1903
Phone (865) 673-5000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Q046854 | Medicaid | TN |
Other providers in Gray, TN
- Abigail Brown
- Cydney Shea Bunn
- Melissa Gail Campbell
- Care Focus, Inc.
- Emily Carpenter
- Landon S Combs
- Stephen P Combs
- Confidential Counseling Solutions LLC
- Kathryn Contel
- William Joseph Cote
All providers in Gray, TN · Family Nurse Practitioner in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 2, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.