Provider Demographics
NPI:1336237338
Name:BAILEY MASON, CARLYN (APN-C)
Entity Type:Individual
Prefix:
First Name:CARLYN
Middle Name:
Last Name:BAILEY MASON
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 LANARK AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-4525
Mailing Address - Country:US
Mailing Address - Phone:214-434-8590
Mailing Address - Fax:
Practice Address - Street 1:2002 LANARK AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-4525
Practice Address - Country:US
Practice Address - Phone:214-434-8590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP114411363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177846601Medicaid
TX8G2002Medicare ID - Type Unspecified
TX177846601Medicaid