Provider Demographics
NPI:1508496415
Name:CARROLL, URSULA THEUS (PA-C)
Entity Type:Individual
Prefix:
First Name:URSULA
Middle Name:THEUS
Last Name:CARROLL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2689 S WOODLOCH ST
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385-8557
Mailing Address - Country:US
Mailing Address - Phone:318-655-3705
Mailing Address - Fax:
Practice Address - Street 1:13310 BEAMER RD STE B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6045
Practice Address - Country:US
Practice Address - Phone:832-879-2942
Practice Address - Fax:832-962-4937
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA13258363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant