Healthcare Provider Details

I. General information

NPI: 1134664618
Provider Name (Legal Business Name): CAROLYN ANN MCCALL NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2016
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 E VILLA MARIA RD STE A
BRYAN TX
77802
US

IV. Provider business mailing address

2010 E VILLA MARIA RD STE A
BRYAN TX
77802-2583
US

V. Phone/Fax

Practice location:
  • Phone: 979-821-7629
  • Fax: 979-821-7631
Mailing address:
  • Phone: 979-821-7629
  • Fax: 979-821-7631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP133004
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: