Healthcare Provider Details

I. General information

NPI: 1356817357
Provider Name (Legal Business Name): CARYN RESNICK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 10/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 NE LOOP 286
PARIS TX
75460-5004
US

IV. Provider business mailing address

775 BEAVER CREEK RD
POWDERLY TX
75473-5660
US

V. Phone/Fax

Practice location:
  • Phone: 903-737-4515
  • Fax: 903-737-8948
Mailing address:
  • Phone: 903-669-2477
  • Fax: 903-784-6841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SX0200X
TaxonomyOncology Clinical Nurse Specialist
License NumberAP139186
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP139186
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: