MEDICARE: CARLY CARRASCO

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1982556460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLY CARRASCO

Provider Business Mailing Address
First Line	:	6801 BURNET RD APT 457
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78757-2958
Country	:	US
Telephone Number	:	361-537-3032
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 N WASHINGTON AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-1754
Country	:	US
Telephone Number	:	972-576-9100
Fax Number	:

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

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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Directions to “ CARLY CARRASCO ” Practice Location

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