Healthcare Provider Details

I. General information

NPI: 1407894223
Provider Name (Legal Business Name): CARLA HAY PERDUE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARLA JEAN HAY NP

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SW 25TH AVE STE 300
MINERAL WELLS TX
76067-8242
US

IV. Provider business mailing address

400 SW 25TH AVE
MINERAL WELLS TX
76067-8246
US

V. Phone/Fax

Practice location:
  • Phone: 940-328-6239
  • Fax: 940-328-7051
Mailing address:
  • Phone: 940-325-7891
  • Fax: 940-328-6523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number236706
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP103488
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: