Healthcare Provider Details

I. General information

NPI: 1306832019
Provider Name (Legal Business Name): CAROLYN KAY CARAWAY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLYN KAY SWINT FNP

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 N. 10TH ST.
FORT SUMNER NM
88119-0349
US

IV. Provider business mailing address

546 N 10TH STREET
FORT SUMNER NM
88119-0349
US

V. Phone/Fax

Practice location:
  • Phone: 575-355-2414
  • Fax: 575-355-7894
Mailing address:
  • Phone: 575-355-2414
  • Fax: 575-355-7894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR56759
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: