Provider Demographics
NPI:1306832019
Name:CARAWAY, CAROLYN KAY (FNP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:KAY
Last Name:CARAWAY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:KAY
Other - Last Name:SWINT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:546 N 10TH STREET
Mailing Address - Street 2:
Mailing Address - City:FORT SUMNER
Mailing Address - State:NM
Mailing Address - Zip Code:88119-0349
Mailing Address - Country:US
Mailing Address - Phone:575-355-2414
Mailing Address - Fax:575-355-7894
Practice Address - Street 1:546 N. 10TH ST.
Practice Address - Street 2:
Practice Address - City:FORT SUMNER
Practice Address - State:NM
Practice Address - Zip Code:88119-0349
Practice Address - Country:US
Practice Address - Phone:575-355-2414
Practice Address - Fax:575-355-7894
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR56759207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092912701Medicaid
NMS702Medicaid
NMS702Medicaid
TX83N491Medicare ID - Type Unspecified