Provider Demographics
NPI:1760969174
Name:WARD, CARLYE NICOLE (NP)
Entity Type:Individual
Prefix:MRS
First Name:CARLYE
Middle Name:NICOLE
Last Name:WARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3693 N DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-7985
Mailing Address - Country:US
Mailing Address - Phone:559-348-9255
Mailing Address - Fax:
Practice Address - Street 1:9483 N FORT WASHINGTON RD STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93730-5938
Practice Address - Country:US
Practice Address - Phone:559-439-1835
Practice Address - Fax:559-439-3936
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009444363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily