Healthcare Provider Details

I. General information

NPI: 1881046381
Provider Name (Legal Business Name): CARRIE EASTON URBAN DNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARRIE ANN EASTON DNP, PMHNP-BC

II. Dates (important events)

Enumeration Date: 07/07/2016
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 482
FPO AP
96362-9998
US

IV. Provider business mailing address

PSC 482 BOX 98
FPO AP
96362-0099
US

V. Phone/Fax

Practice location:
  • Phone: 011810989717135
  • Fax:
Mailing address:
  • Phone: 0118031503831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024172902
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: