Provider Demographics
NPI:1710496286
Name:SPRAYBERRY, CARRIE ELAINE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:ELAINE
Last Name:SPRAYBERRY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:CARRIE
Other - Middle Name:ELAINE
Other - Last Name:VALDERRAMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1120 MEDICAL PLAZA DR STE 255
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3213
Mailing Address - Country:US
Mailing Address - Phone:281-205-1111
Mailing Address - Fax:281-419-2111
Practice Address - Street 1:106 VISION PARK BLVD
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3000
Practice Address - Country:US
Practice Address - Phone:713-442-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135375363LF0000X
TXF09171187363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX402834202Medicaid