Provider Demographics
NPI:1467670174
Name:MOBLEY, CAROLYN ELIZABETH (APRN, FNP-C, CPNP-AC)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:ELIZABETH
Last Name:MOBLEY
Suffix:
Gender:F
Credentials:APRN, FNP-C, CPNP-AC
Other - Prefix:MRS
Other - First Name:CAROLYN
Other - Middle Name:MOBLEY
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4702 WESTMINSTER DR
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-5911
Mailing Address - Country:US
Mailing Address - Phone:214-505-0363
Mailing Address - Fax:
Practice Address - Street 1:3959 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1559
Practice Address - Country:US
Practice Address - Phone:214-505-0363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136125363LF0000X, 363LP0222X, 363L00000X
NYF346211363LF0000X
NYF383143363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical CareGroup - Multi-Specialty