Provider Demographics
NPI:1336867472
Name:CANO, CARLY SUE (FNPC)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:SUE
Last Name:CANO
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 AVENUE H NW
Mailing Address - Street 2:
Mailing Address - City:CHILDRESS
Mailing Address - State:TX
Mailing Address - Zip Code:79201-3037
Mailing Address - Country:US
Mailing Address - Phone:806-205-0871
Mailing Address - Fax:
Practice Address - Street 1:402 AVENUE H NW
Practice Address - Street 2:
Practice Address - City:CHILDRESS
Practice Address - State:TX
Practice Address - Zip Code:79201-3037
Practice Address - Country:US
Practice Address - Phone:806-205-0871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF08220631363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily