Provider Demographics
NPI:1275934689
Name:CASTRO-BYRD, CARMEN NYDIA
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:NYDIA
Last Name:CASTRO-BYRD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 HARMON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-5641
Mailing Address - Country:US
Mailing Address - Phone:912-435-1329
Mailing Address - Fax:912-435-6149
Practice Address - Street 1:1061 HARMON AVE
Practice Address - Street 2:
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5641
Practice Address - Country:US
Practice Address - Phone:912-435-1329
Practice Address - Fax:912-435-6149
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-05
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9239238261QM1300X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty