Provider Demographics
NPI:1740731512
Name:BROCKRIEDE, CARRIE M (CNM)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:M
Last Name:BROCKRIEDE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:M
Other - Last Name:VIETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 MIDWESTERN PKWY E
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76302-2302
Mailing Address - Country:US
Mailing Address - Phone:940-763-7834
Mailing Address - Fax:940-763-7817
Practice Address - Street 1:912 BURNETT ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-3208
Practice Address - Country:US
Practice Address - Phone:940-285-5052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132282367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife