Provider Demographics
NPI:1669476115
Name:DAVIS, CAROLYN (RN FNPC)
Entity Type:Individual
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First Name:CAROLYN
Middle Name:
Last Name:DAVIS
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Gender:F
Credentials:RN FNPC
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Mailing Address - Street 1:3150 CLARKSVILLE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-8076
Mailing Address - Country:US
Mailing Address - Phone:903-782-9206
Mailing Address - Fax:903-783-7367
Practice Address - Street 1:3150 CLARKSVILLE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-8076
Practice Address - Country:US
Practice Address - Phone:903-782-9206
Practice Address - Fax:903-783-7367
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2015-03-10
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Provider Licenses
StateLicense IDTaxonomies
TX249096363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS19934Medicare UPIN