Individual
CAROLYN R FEGENBUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1802 E 10TH ST, JEFFERSONVILLE, IN 47130-6016
(812) 288-2488
(770) 573-9513
Mailing address
2100 MARKET ST STE 101, CHARLESTOWN, IN 47111-9535
(812) 503-5100
(770) 573-9513
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
71001579A
IN
363L00000X
Nurse Practitioner
Primary
71001579A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200451720
—
IN
01
—
2823492000
PASSPORT ADVANTAGE
—
01
—
50014111
PASSPORT
—
05
—
78010824
—
KY
01
—
P00424435
RAILROAD MEDICARE
—
Enumeration date
07/06/2006
Last updated
11/08/2021
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