Healthcare Provider Details

I. General information

NPI: 1871396614
Provider Name (Legal Business Name): CHARLIE VERA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 HOUSTON ST
CASTROVILLE TX
78009-2739
US

IV. Provider business mailing address

PO BOX 1457
CASTROVILLE TX
78009-1457
US

V. Phone/Fax

Practice location:
  • Phone: 830-538-3550
  • Fax: 830-538-3553
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1193806
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: