Healthcare Provider Details

I. General information

NPI: 1124652409
Provider Name (Legal Business Name): CAROL BARNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1169 ACR 182
ELKHART TX
75839
US

IV. Provider business mailing address

1169 ACR 182
ELKHART TX
75839
US

V. Phone/Fax

Practice location:
  • Phone: 936-645-1686
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number312244
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: