Provider Demographics
NPI:1245275825
Name:LIESER, CAROL S (APN)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:S
Last Name:LIESER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 W AIRPORT FWY
Mailing Address - Street 2:STE 244
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-5832
Mailing Address - Country:US
Mailing Address - Phone:972-252-2945
Mailing Address - Fax:888-975-2092
Practice Address - Street 1:4425 W AIRPORT FWY
Practice Address - Street 2:STE 244
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-5832
Practice Address - Country:US
Practice Address - Phone:972-252-2945
Practice Address - Fax:888-975-2092
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX462622363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXNP7659OtherBCBS
TX7262601OtherAETNA
TX167511803Medicaid
TX8L22249Medicare PIN
TX167511802Medicaid
TX167511804Medicaid
TX819N61OtherBCBS