Provider Demographics
NPI:1063837078
Name:TIMS, CAROLYN
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:TIMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:CEDAR LANE
Mailing Address - State:TX
Mailing Address - Zip Code:77415-0001
Mailing Address - Country:US
Mailing Address - Phone:979-900-9256
Mailing Address - Fax:
Practice Address - Street 1:201 E MYRTLE ST
Practice Address - Street 2:SUITE 216
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-4763
Practice Address - Country:US
Practice Address - Phone:979-900-9256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-27
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No374U00000XNursing Service Related ProvidersHome Health Aide