Individual
BRIDGETTE LOREEN CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, FNP-C
Contact information
Practice address
865 TAYLORSVILLE RD, SHELBYVILLE, KY 40065-9124
(502) 437-0450
Mailing address
6210 CAMDEN CIR, CRESTWOOD, KY 40014-8847
(502) 724-9325
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
6186P
KY
2084N0400X
Neurology Physician
6186P
KY
363L00000X
Nurse Practitioner
Primary
3006186
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000623052
ANTHEM
KY
01
—
113935
SIHO NICC
KY
01
—
3737633000
PASSPORT ADVANTAGE
KY
01
—
50025786
PASSPORT
KY
Enumeration date
06/01/2009
Last updated
03/17/2018
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