Provider Demographics
NPI:1801936935
Name:CORPUS CARE
Entity type:Organization
Organization Name:CORPUS CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:PETTY
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:361-857-2273
Mailing Address - Street 1:4710 EVERHART RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-2750
Mailing Address - Country:US
Mailing Address - Phone:361-857-2273
Mailing Address - Fax:866-227-3199
Practice Address - Street 1:4710 EVERHART RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-2750
Practice Address - Country:US
Practice Address - Phone:361-857-2273
Practice Address - Fax:866-227-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX577955TX363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty