Provider Demographics
NPI:1790943660
Name:DAVIS-TEAGUE, CAROLYN LEIGH (MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:LEIGH
Last Name:DAVIS-TEAGUE
Suffix:
Gender:F
Credentials:MSN, FNP-BC
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Mailing Address - Street 1:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0853
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:972-715-9976
Practice Address - Street 1:1500 CITYWEST BLVD
Practice Address - Street 2:STE. 300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-2300
Practice Address - Country:US
Practice Address - Phone:713-620-4000
Practice Address - Fax:713-458-4229
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2020-04-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXAP120773363L00000X
TX662410363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01553405OtherRR MEDICARE
TX296115302Medicaid
TX8N0160OtherBCBS
TX296115303Medicaid
TXP01553405OtherRR MEDICARE