=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356817357
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARYN RESNICK FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2018
-----------------------------------------------------
Last Update Date | 10/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3550 NE LOOP 286
-----------------------------------------------------
City | PARIS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75460-5004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-737-4515
-----------------------------------------------------
Fax | 903-737-8948
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 775 BEAVER CREEK RD
-----------------------------------------------------
City | POWDERLY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75473-5660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-669-2477
-----------------------------------------------------
Fax | 903-784-6841
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364SX0200X
-----------------------------------------------------
Taxonomy Name | Oncology Clinical Nurse Specialist
-----------------------------------------------------
License Number | AP139186
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP139186
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------