Provider Demographics
NPI:1437665528
Name:CARLSON, AARON (AGNP)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:CARLSON
Suffix:
Gender:M
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 N AMBURN RD STE 9
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77591-2466
Mailing Address - Country:US
Mailing Address - Phone:281-218-7200
Mailing Address - Fax:409-359-7403
Practice Address - Street 1:1501 N AMBURN RD STE 9
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-2466
Practice Address - Country:US
Practice Address - Phone:281-218-7200
Practice Address - Fax:409-359-7403
Is Sole Proprietor?:No
Enumeration Date:2017-12-27
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135593363LA2200X
COAPN.0993486-NP363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AG09170162OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS AGNP CERTIFICATION
COAPN.0993486-NPOtherAPRN STATE LICENSE
TX24636OtherTEXAS PRESCRIPTIVE AUTHORITY
TXAP135593OtherAPRN STATE LICENSE
CORXN.0103049-NPOtherCOLORADO PRESCRIPTIVE AUTHORITY