Provider Demographics
NPI:1760988919
Name:ST JOHN, CARLENE ARETA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CARLENE
Middle Name:ARETA
Last Name:ST JOHN
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 1:4815 STATE HIGHWAY 121
Mailing Address - Street 2:SUITE 8
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-2905
Mailing Address - Country:US
Mailing Address - Phone:214-619-1770
Mailing Address - Fax:214-619-1775
Practice Address - Street 1:4815 STATE HIGHWAY 121 STE 8
Practice Address - Street 2:
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-2905
Practice Address - Country:US
Practice Address - Phone:214-619-1770
Practice Address - Fax:214-619-1775
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2020-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137633363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily