Provider Demographics
NPI:1093748998
Name:DAVIDSON, CAROL LYNN (APN)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:LYNN
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:RR 3 BOX 158
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:TX
Mailing Address - Zip Code:76374-9788
Mailing Address - Country:US
Mailing Address - Phone:940-873-4691
Mailing Address - Fax:940-873-4691
Practice Address - Street 1:306 W MAIN ST
Practice Address - Street 2:BOX 308
Practice Address - City:OLNEY
Practice Address - State:TX
Practice Address - Zip Code:76374-1851
Practice Address - Country:US
Practice Address - Phone:940-564-3546
Practice Address - Fax:940-564-8882
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX559769363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP60479Medicare UPIN