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General NPI Number Information
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NPI Number | 1487404539
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Entity Type | Individual
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Provider Name | CEARRA COREY DNP, APRN, AGCNS-BS
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Gender | Female
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Dates
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Enumeration Date | 03/22/2024
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Last Update Date | 03/22/2024
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Provider Practice Location Address
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Address Line | 9427 N BEACH ST
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City | FORT WORTH
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State | TX
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Zip | 76244-9059
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Country | US
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Telephone | 817-562-5698
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Fax |
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Provider Business Mailing Address
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Address Line | 1716 FRIEDRICH DR
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City | MANSFIELD
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State | TX
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Zip | 76063-4275
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Country | US
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Telephone | 225-250-9490
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0050X
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Taxonomy Name | Non-Surgical Family Planning Clinic/Center
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License Number | 1153195
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License Number State | TX
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