Provider Demographics
NPI:1235743105
Name:WADDELL, CARROL ANN (FNP)
Entity Type:Individual
Prefix:
First Name:CARROL
Middle Name:ANN
Last Name:WADDELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8229 ROCK CREST DR
Mailing Address - Street 2:
Mailing Address - City:CORP CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-6272
Mailing Address - Country:US
Mailing Address - Phone:830-444-9427
Mailing Address - Fax:
Practice Address - Street 1:8229 ROCK CREST DR
Practice Address - Street 2:
Practice Address - City:CORP CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-6272
Practice Address - Country:US
Practice Address - Phone:830-444-9427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1012061363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner