Provider Demographics
NPI:1265734370
Name:KALLMEYER, CAROLYN ELIZABETH (APRN)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ELIZABETH
Last Name:KALLMEYER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:ELIZABETH
Other - Last Name:CAUHORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2620 ELM HILL PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3108
Mailing Address - Country:US
Mailing Address - Phone:615-425-4211
Mailing Address - Fax:615-425-4201
Practice Address - Street 1:2150 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:FT MITCHELL
Practice Address - State:KY
Practice Address - Zip Code:41017-2902
Practice Address - Country:US
Practice Address - Phone:859-292-1784
Practice Address - Fax:859-292-1785
Is Sole Proprietor?:No
Enumeration Date:2010-11-22
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004450363LF0000X, 364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health