Healthcare Provider Details

I. General information

NPI: 1225289655
Provider Name (Legal Business Name): CAROLINE JEAN COYNER-SUCH WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2008
Last Update Date: 10/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 UHLAND RD 107
SAN MARCOS TX
78666-6630
US

IV. Provider business mailing address

PO BOX 748
SAN MARCOS TX
78667-0748
US

V. Phone/Fax

Practice location:
  • Phone: 512-392-1161
  • Fax: 512-392-3530
Mailing address:
  • Phone: 512-392-1161
  • Fax: 512-392-3530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number535767
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: