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General NPI Number Information
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NPI Number | 1558966291
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Entity Type | Individual
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Provider Name | CARRIE LYNN PARK APRN, FNP-BC, WCC
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Gender | Female
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Dates
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Enumeration Date | 12/01/2020
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 601 WESTPARK WAY STE 200
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City | EULESS
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State | TX
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Zip | 76040-3972
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Country | US
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Telephone | 817-921-1886
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Fax | 817-768-6424
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Provider Business Mailing Address
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Address Line | 557 BIG BEND DR
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City | KELLER
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State | TX
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Zip | 76248-2525
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Country | US
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Telephone | 817-201-3424
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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 | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number | 867158
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1012559
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License Number State | TX
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