Provider Demographics
NPI:1285201582
Name:CARSON, LACRESHA QUWANISH (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LACRESHA
Middle Name:QUWANISH
Last Name:CARSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6213 RYAN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-7727
Mailing Address - Country:US
Mailing Address - Phone:903-701-8032
Mailing Address - Fax:
Practice Address - Street 1:6213 RYAN CREEK RD
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-7727
Practice Address - Country:US
Practice Address - Phone:903-701-8032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1019234208100000X, 208VP0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine