Provider Demographics
NPI:1942320593
Name:GATLIN, CARMEN G (ACNP)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:G
Last Name:GATLIN
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:G
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1550 MOORES LN
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-4657
Mailing Address - Country:US
Mailing Address - Phone:903-793-7378
Mailing Address - Fax:
Practice Address - Street 1:1550 MOORES LN
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4657
Practice Address - Country:US
Practice Address - Phone:903-793-7378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR52539363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARR52539OtherARK NURSING LIC ACNP CRED
TXMG4503172OtherDEA