Provider Demographics
NPI:1467840546
Name:VAN DEVENTER, CARYN (DO)
Entity Type:Individual
Prefix:
First Name:CARYN
Middle Name:
Last Name:VAN DEVENTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5757 WARREN PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4777
Mailing Address - Country:US
Mailing Address - Phone:972-777-3232
Mailing Address - Fax:972-777-3131
Practice Address - Street 1:5757 WARREN PKWY STE 200
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4777
Practice Address - Country:US
Practice Address - Phone:972-777-3232
Practice Address - Fax:972-777-3131
Is Sole Proprietor?:No
Enumeration Date:2014-12-25
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ390200000X
TXS5098207V00000X
TXBP10056832207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program