Provider Demographics
NPI:1679214563
Name:MAUPIN, CARRIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:MAUPIN
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 10880
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-0880
Mailing Address - Country:US
Mailing Address - Phone:928-759-5874
Mailing Address - Fax:
Practice Address - Street 1:1001 WILLOW CREEK RD STE 1300
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1614
Practice Address - Country:US
Practice Address - Phone:928-708-4554
Practice Address - Fax:928-458-2108
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ271551363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ271551OtherBOARD OF NURSING
MM7133705OtherUS DEPT OF JUSTICE - DRUG ENFORCEMENT ADMINISTRATION