Provider Demographics
NPI:1093064651
Name:LIMO, CAROLYNE CHEBET (NP)
Entity Type:Individual
Prefix:
First Name:CAROLYNE
Middle Name:CHEBET
Last Name:LIMO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CAROLYNE
Other - Middle Name:
Other - Last Name:CHERUIYOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11805 INDIAN PONY WAY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-5298
Mailing Address - Country:US
Mailing Address - Phone:515-988-3230
Mailing Address - Fax:
Practice Address - Street 1:6300 SAMUELL BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-7137
Practice Address - Country:US
Practice Address - Phone:214-381-1910
Practice Address - Fax:214-381-2868
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX767889207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine