MEDICARE: CAROLINE CHANCE CORLEY NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1094077	TX

General Provider Information

NPI Number	:	1730969429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE CHANCE CORLEY NP

Provider Business Mailing Address
First Line	:	3900 NE STALLINGS DR STE 101
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-2111
Country	:	US
Telephone Number	:	936-559-8770
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 NE STALLINGS DR STE 101
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-2111
Country	:	US
Telephone Number	:	936-559-8770
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2023
Last Update Date	:	03/16/2026

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