Provider Demographics
NPI:1942901541
Name:CARRUTH, NAELYN CELESTE (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:NAELYN
Middle Name:CELESTE
Last Name:CARRUTH
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:MISS
Other - First Name:NAELYN
Other - Middle Name:CELESTE
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15828 STEPNEY WAY
Mailing Address - Street 2:
Mailing Address - City:JUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:76247-1949
Mailing Address - Country:US
Mailing Address - Phone:360-489-7962
Mailing Address - Fax:
Practice Address - Street 1:401 W CENTERVILLE RD STE 1
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-5400
Practice Address - Country:US
Practice Address - Phone:972-840-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX943742163WX0003X
TX1126794363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient