Provider Demographics
NPI:1386206977
Name:CERVANTES, KARLA ALEXANDRA
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:ALEXANDRA
Last Name:CERVANTES
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 1:4505 82ND ST STE 5
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-3219
Mailing Address - Country:US
Mailing Address - Phone:806-696-4440
Mailing Address - Fax:806-696-4441
Practice Address - Street 1:4505 82ND ST STE 5
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-3219
Practice Address - Country:US
Practice Address - Phone:806-696-4440
Practice Address - Fax:806-696-4441
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011959363LC1500X
TXAP139529363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health