Provider Demographics
NPI:1649753104
Name:WRIGHT, CAROLYN JOYCE (LVN)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:JOYCE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MRS
Other - First Name:CAROLYN
Other - Middle Name:JOYCE
Other - Last Name:LEROY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:712 SHADY HILL LN.
Mailing Address - Street 2:
Mailing Address - City:SPRINGTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:76082
Mailing Address - Country:US
Mailing Address - Phone:817-565-7605
Mailing Address - Fax:
Practice Address - Street 1:6115 CAMP BOWIE BLVD STE 290
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-5500
Practice Address - Country:US
Practice Address - Phone:817-831-1105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX196450164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196450OtherLICENSED VOCATIONAL NURSE