Healthcare Provider Details

I. General information

NPI: 1245194174
Provider Name (Legal Business Name): CARLA ALISON CANTUALLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4521 VANCE RD
NORTH RICHLAND HILLS TX
76180-8161
US

IV. Provider business mailing address

4521 VANCE RD
NORTH RICHLAND HILLS TX
76180-8161
US

V. Phone/Fax

Practice location:
  • Phone: 913-808-7307
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2025045459
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: