Provider Demographics
NPI:1588795710
Name:MACKAVEY, CAROLE LOUISE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:LOUISE
Last Name:MACKAVEY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 TRIXIE LANE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-2634
Mailing Address - Country:US
Mailing Address - Phone:713-334-8236
Mailing Address - Fax:281-648-4437
Practice Address - Street 1:1919 NORTH LOOP W
Practice Address - Street 2:SUITE 218
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1374
Practice Address - Country:US
Practice Address - Phone:713-862-5797
Practice Address - Fax:713-861-0166
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX639142363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ49192Medicare UPIN