MEDICARE: CAROLYNE CHEBET LIMO NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	767889	TX

General Provider Information

NPI Number	:	1093064651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYNE CHEBET LIMO NP

Provider Business Mailing Address
First Line	:	11805 INDIAN PONY WAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5298
Country	:	US
Telephone Number	:	515-988-3230
Fax Number	:

Provider Business Practice Location Address
First Line	:	6300 SAMUELL BLVD
Second Line	:	SUITE 120
City	:	DALLAS
State	:	TX
Zip	:	75228-7137
Country	:	US
Telephone Number	:	214-381-1910
Fax Number	:	214-381-2868

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2012
Last Update Date	:	04/18/2019

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