Provider Demographics
NPI:1578108254
Name:AINSWORTH, CARISSA ARIELLE (FNP)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:ARIELLE
Last Name:AINSWORTH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:CARISSA
Other - Middle Name:A
Other - Last Name:WEATHERLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3111 PALM ISLAND CIR
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-5986
Mailing Address - Country:US
Mailing Address - Phone:281-787-6174
Mailing Address - Fax:
Practice Address - Street 1:360 E MEDICAL CENTER BLVD STE A
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4321
Practice Address - Country:US
Practice Address - Phone:832-932-5669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-17
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF05190775261QI0500X
TXAP142585363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy