Healthcare Provider Details

I. General information

NPI: 1548353071
Provider Name (Legal Business Name): CARRIE LEA HALL CRNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W MAIN ST STE 200
LEWISVILLE TX
75057-3639
US

IV. Provider business mailing address

1853 MEYERWOOD LN N
FLOWER MOUND TX
75028-7310
US

V. Phone/Fax

Practice location:
  • Phone: 972-420-1776
  • Fax: 972-436-6996
Mailing address:
  • Phone: 972-355-0338
  • Fax: 972-355-0338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number2-44964
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: