MEDICARE: KARIN MARIE WOMACK MSN FNP

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	AP136256	TX

General Provider Information

NPI Number	:	1609219096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARIN MARIE WOMACK MSN FNP

Provider Business Mailing Address
First Line	:	3251 I 45 N STE 100
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-2185
Country	:	US
Telephone Number	:	936-441-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	8558 CREEKSIDE FOREST DR BLDG B
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77375-2175
Country	:	US
Telephone Number	:	832-534-7700
Fax Number	:

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

Provider Enumeration Date	:	04/16/2013
Last Update Date	:	10/14/2020

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