Provider Demographics
NPI:1861139826
Name:RADDING, CARRIE LYNNE (PMHNP-APN)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYNNE
Last Name:RADDING
Suffix:
Gender:F
Credentials:PMHNP-APN
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:LYNNE
Other - Last Name:WOLVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:108 CONEJO PL
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5811
Mailing Address - Country:US
Mailing Address - Phone:970-749-7997
Mailing Address - Fax:
Practice Address - Street 1:108 CONEJO PL
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301
Practice Address - Country:US
Practice Address - Phone:720-507-4779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0997592-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty