Healthcare Provider Details

I. General information

NPI: 1962117598
Provider Name (Legal Business Name): ALICIA CARLSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7212 INDEPENDENCE PKWY
PLANO TX
75025-5761
US

IV. Provider business mailing address

7212 INDEPENDENCE PKWY
PLANO TX
75025-5761
US

V. Phone/Fax

Practice location:
  • Phone: 972-618-2493
  • Fax:
Mailing address:
  • Phone: 972-618-2493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1217039
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: