Provider Demographics
NPI:1366463887
Name:CARVER, MARY E (MSN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:CARVER
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-2732
Mailing Address - Country:US
Mailing Address - Phone:972-551-7500
Mailing Address - Fax:972-524-7418
Practice Address - Street 1:200 N VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-2732
Practice Address - Country:US
Practice Address - Phone:972-551-7500
Practice Address - Fax:972-524-7418
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX529863363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160592-01Medicaid
TX8N4489OtherBCBSTX
TX160592-01Medicaid
TXQ04898Medicare UPIN