Provider Demographics
NPI:1851508642
Name:PRESTON, CAROL (RN,MSM,PNP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:PRESTON
Suffix:
Gender:F
Credentials:RN,MSM,PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18802 N THOMAS SHORE DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-2394
Mailing Address - Country:US
Mailing Address - Phone:281-341-9696
Mailing Address - Fax:281-341-6218
Practice Address - Street 1:1300 MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-3348
Practice Address - Country:US
Practice Address - Phone:281-341-9696
Practice Address - Fax:281-341-6218
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX07460363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX07460OtherNURSE PRACTITONER