Healthcare Provider Details

I. General information

NPI: 1215865365
Provider Name (Legal Business Name): PHILLIP RANDALL CARR RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 GOLDEN OAKS DR
GEORGETOWN TX
78628-3318
US

IV. Provider business mailing address

107 JUNIPER BERRY TRL
GEORGETOWN TX
78633-4705
US

V. Phone/Fax

Practice location:
  • Phone: 512-963-9168
  • Fax:
Mailing address:
  • Phone: 512-963-9168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number1000662
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: