=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730951443
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAYTON BRIANNE CARVER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2023
-----------------------------------------------------
Last Update Date | 07/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 910 E HOUSTON ST STE 330
-----------------------------------------------------
City | TYLER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75702-8368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-606-7995
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 814 COUNTY ROAD 2906
-----------------------------------------------------
City | MINEOLA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75773-6135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-690-9636
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 1011914
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------