Healthcare Provider Details

I. General information

NPI: 1174087704
Provider Name (Legal Business Name): CARLIN BRAE HURST FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARLIN BLANCHARD-BLACKBURN

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20783 INTERSTATE 20 S ACCESS RD
CANTON TX
75103-3573
US

IV. Provider business mailing address

20783 INTERSTATE 20 S ACCESS RD
CANTON TX
75103-3573
US

V. Phone/Fax

Practice location:
  • Phone: 903-567-5437
  • Fax: 844-678-6258
Mailing address:
  • Phone: 402-598-5089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP140364
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: