Provider Demographics
NPI:1639157217
Name:CARR, NATHAN L (CRNA)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:L
Last Name:CARR
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3744
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-3744
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4228 N MCCOLL RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2523
Practice Address - Country:US
Practice Address - Phone:956-682-4151
Practice Address - Fax:956-682-4154
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX588086367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX109917804Medicaid
TX82581UOtherBCBS
TX109917804Medicaid
TXR73210Medicare UPIN