Provider Demographics
NPI:1255834719
Name:CULBERTSON, CARRIE (FNP-C, CNM)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:CULBERTSON
Suffix:
Gender:F
Credentials:FNP-C, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12221 RENFERT WAY STE 330
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5374
Mailing Address - Country:US
Mailing Address - Phone:512-425-3825
Mailing Address - Fax:
Practice Address - Street 1:12221 RENFERT WAY STE 330
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5374
Practice Address - Country:US
Practice Address - Phone:512-425-3825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-12
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136307363LF0000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily