Provider Demographics
NPI:1558380162
Name:CARLSON, MICHELLE LEE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:LEE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11233 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-3132
Mailing Address - Country:US
Mailing Address - Phone:806-335-5101
Mailing Address - Fax:806-335-5101
Practice Address - Street 1:11233 WINDSOR DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-3132
Practice Address - Country:US
Practice Address - Phone:806-335-5101
Practice Address - Fax:806-335-5101
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP112977363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX210755901Medicaid
TX210755902Medicaid
TX528492YLPSOtherWELLMED PTAN
TX210755902Medicaid