Provider Demographics
NPI:1245292671
Name:KICK, CAROL CROWELL (FNP)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:CROWELL
Last Name:KICK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 S HIGHWAY 78
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-4004
Mailing Address - Country:US
Mailing Address - Phone:972-442-4888
Mailing Address - Fax:972-442-4970
Practice Address - Street 1:791 S HIGHWAY 78
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-4004
Practice Address - Country:US
Practice Address - Phone:972-442-4888
Practice Address - Fax:972-429-0366
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX521436363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX521436OtherRN
80132442OtherDPS
MK1072949OtherDEA REG
P27216Medicare UPIN
85N846Medicare ID - Type Unspecified