1972860930 NPI number — MRS. SHIRLEY CARRENARD-MCDOWELL FNP, PMHNP

Table of content: MRS. SHIRLEY CARRENARD-MCDOWELL FNP, PMHNP (NPI 1972860930)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972860930 NPI number — MRS. SHIRLEY CARRENARD-MCDOWELL FNP, PMHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARRENARD-MCDOWELL
Provider First Name:
SHIRLEY
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP, PMHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARRENARD
Provider Other First Name:
SHIRLEY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PMHNP, FNP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1972860930
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 SUMMIT AVE STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27405-7813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-907-4345
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 COMMUNITY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANHASSET
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11030-3816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-823-8855
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  5009070 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 336942 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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