Healthcare Provider Details

I. General information

NPI: 1295985059
Provider Name (Legal Business Name): VICKI CARR MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2008
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20311 KUYKENDAHL RD
SPRING TX
77379-2611
US

IV. Provider business mailing address

20311 KUYKENDAHL RD
SPRING TX
77379-2611
US

V. Phone/Fax

Practice location:
  • Phone: 832-717-3376
  • Fax: 832-717-0004
Mailing address:
  • Phone: 832-717-3376
  • Fax: 832-717-0004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberM7894
License Number StateTX

VIII. Authorized Official

Name: DR. VICKI L CARR
Title or Position: PRESIDENT
Credential: MD
Phone: 832-717-3376