Provider Demographics
NPI:1437934106
Name:DUDLEY, CARISSA MAE (PNP-PC)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:MAE
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:PNP-PC
Other - Prefix:
Other - First Name:CARI
Other - Middle Name:
Other - Last Name:DUDLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PNP-PC
Mailing Address - Street 1:309 COVEY LN
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-0330
Mailing Address - Country:US
Mailing Address - Phone:214-293-0874
Mailing Address - Fax:
Practice Address - Street 1:230 E SYCAMORE ST STE 100
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-5012
Practice Address - Country:US
Practice Address - Phone:903-202-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1087024363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics