Provider Demographics
NPI:1427022342
Name:EARNEST, CAROLYN (RN, CNS)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:EARNEST
Suffix:
Gender:F
Credentials:RN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 LAURENCE DR # 476
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:TX
Mailing Address - Zip Code:75032-2092
Mailing Address - Country:US
Mailing Address - Phone:505-995-0170
Mailing Address - Fax:
Practice Address - Street 1:17547 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-6039
Practice Address - Country:US
Practice Address - Phone:505-995-0170
Practice Address - Fax:855-725-7450
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR20641364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000B0832Medicaid
NMS90860Medicare UPIN