Healthcare Provider Details

I. General information

NPI: 1750496469
Provider Name (Legal Business Name): CAROL LEE HUNNICUTT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 04/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8230 WALNUT HILL LN STE 208
DALLAS TX
75231-4409
US

IV. Provider business mailing address

8230 WALNUT HILL LN STE 208
DALLAS TX
75231-4409
US

V. Phone/Fax

Practice location:
  • Phone: 214-692-6135
  • Fax: 214-692-6265
Mailing address:
  • Phone: 214-692-6135
  • Fax: 214-692-6265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA00519
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: