Provider Demographics
NPI:1063682177
Name:REYES, CAROL A (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:A
Last Name:REYES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4909 BLUE WATER LN
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-6501
Mailing Address - Country:US
Mailing Address - Phone:832-738-1886
Mailing Address - Fax:
Practice Address - Street 1:4909 BLUE WATER LN
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-6501
Practice Address - Country:US
Practice Address - Phone:832-738-1886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX519194363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily