Provider Demographics
NPI:1699177758
Name:CORLEY, EVELYN (APRN FNP-BC)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:CORLEY
Suffix:
Gender:F
Credentials:APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 S CARRIER PKWY
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-1517
Mailing Address - Country:US
Mailing Address - Phone:972-262-1425
Mailing Address - Fax:972-262-4973
Practice Address - Street 1:820 S CARRIER PKWY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-1517
Practice Address - Country:US
Practice Address - Phone:972-262-1425
Practice Address - Fax:972-262-4973
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-20
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR084623163W00000X
ARA004224363LF0000X
TXAP133811363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse