Provider Demographics
NPI:1568189132
Name:CARRILLO, NATALIE ROXANNE (FNP - BC)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:ROXANNE
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:FNP - BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 335
Mailing Address - Street 2:
Mailing Address - City:MINNEOLA
Mailing Address - State:KS
Mailing Address - Zip Code:67865-0335
Mailing Address - Country:US
Mailing Address - Phone:620-253-2108
Mailing Address - Fax:
Practice Address - Street 1:119 N HART ST
Practice Address - Street 2:
Practice Address - City:MEADE
Practice Address - State:KS
Practice Address - Zip Code:67864-6402
Practice Address - Country:US
Practice Address - Phone:620-873-2112
Practice Address - Fax:620-873-5371
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS81611363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily