Provider Demographics
NPI:1093756330
Name:HARDCASTLE, CAROL GWYNNE (MED, LAT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:GWYNNE
Last Name:HARDCASTLE
Suffix:
Gender:F
Credentials:MED, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3930 MILL ROCK CIR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-1739
Mailing Address - Country:US
Mailing Address - Phone:281-980-4770
Mailing Address - Fax:
Practice Address - Street 1:13755 MAIN ST
Practice Address - Street 2:BUTLER SPORTS COMPLEX
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-5445
Practice Address - Country:US
Practice Address - Phone:713-726-2117
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT0368146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant