Provider Demographics
NPI:1558966291
Name:PARK, CARRIE LYNN (APRN, FNP-BC, WCC)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYNN
Last Name:PARK
Suffix:
Gender:F
Credentials:APRN, FNP-BC, WCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4441 LONG PRAIRIE RD
Mailing Address - Street 2:# 400
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1795
Mailing Address - Country:US
Mailing Address - Phone:940-222-5936
Mailing Address - Fax:
Practice Address - Street 1:4441 LONG PRAIRIE RD
Practice Address - Street 2:#400
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028
Practice Address - Country:US
Practice Address - Phone:214-285-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1012559363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily