Provider Demographics
NPI:1124678511
Name:CHARLES, CAROLYN CELESTINE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:CELESTINE
Last Name:CHARLES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 COUNTRY PLACE PKWY STE 160
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-2283
Mailing Address - Country:US
Mailing Address - Phone:832-736-2677
Mailing Address - Fax:832-730-4574
Practice Address - Street 1:1920 COUNTRY PLACE PKWY STE 160
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-2283
Practice Address - Country:US
Practice Address - Phone:281-455-0525
Practice Address - Fax:832-730-4574
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX143100208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143100Medicaid