Provider Demographics
NPI:1255449286
Name:CARPENTER, CATHERINE RENEE (CRNA)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:RENEE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:RENEE
Other - Last Name:FOLSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:303 COUNTY ROAD 144B
Mailing Address - Street 2:
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-8020
Mailing Address - Country:US
Mailing Address - Phone:337-356-3242
Mailing Address - Fax:
Practice Address - Street 1:1305 WONDER WORLD DR STE 105
Practice Address - Street 2:YPS - CREDENTIALING
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7502
Practice Address - Country:US
Practice Address - Phone:512-353-8161
Practice Address - Fax:512-353-8255
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN052364367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1549169Medicaid
TX8179UFOtherBXBS OF TX
TX8179UFOtherBXBS OF TX