MEDICARE: CAROLINA ROCK

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	363LF0000X	Family Nurse Practitioner	1168526	TX

General Provider Information

NPI Number	:	1366286536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINA ROCK

Provider Business Mailing Address
First Line	:	PO BOX 58538
Second Line	:
City	:	WEBSTER
State	:	TX
Zip	:	77598-8538
Country	:	US
Telephone Number	:	832-520-2080
Fax Number	:

Provider Business Practice Location Address
First Line	:	5010 CRENSHAW RD STE 110
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77505-4614
Country	:	US
Telephone Number	:	832-520-2080
Fax Number	:

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

Provider Enumeration Date	:	06/22/2024
Last Update Date	:	02/06/2026

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Directions to “ CAROLINA ROCK ” Practice Location

Language	Start Address	Practice Location

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