Provider Demographics
NPI:1871181073
Name:BYRD, CARLA WAYNETTE (RN, BSN, VACCINATOR)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:WAYNETTE
Last Name:BYRD
Suffix:
Gender:F
Credentials:RN, BSN, VACCINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10623 SARATOGA SQ # DELIVERY
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-2898
Mailing Address - Country:US
Mailing Address - Phone:512-354-5903
Mailing Address - Fax:
Practice Address - Street 1:10623 SARATOGA SQ # DELIVERY
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-2898
Practice Address - Country:US
Practice Address - Phone:512-354-5903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X, 261QP0905X
TX956429163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local