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NPI Code Detail

MEDICARE: MS. DESTIN RANAE CORLEY

MEDICARE: MS. DESTIN RANAE CORLEY
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
1390200000XStudent in an Organized Health Care Education/Training ProgramTX
2367500000XCertified Registered Nurse AnesthetistAP1126351TX

General Provider Information

NPI Number : 1639789134
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DESTIN RANAE CORLEY
Provider Business Mailing Address
First Line : 14850 QUORUM DR STE 400
Second Line :
City : DALLAS
State : TX
Zip : 75254-1445
Country : US
Telephone Number : 469-437-3564
Fax Number : 469-825-6903
Provider Business Practice Location Address
First Line : 14850 QUORUM DR STE 400
Second Line :
City : DALLAS
State : TX
Zip : 75254-1445
Country : US
Telephone Number : 469-437-3564
Fax Number : 469-825-6903
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2020
Last Update Date : 06/29/2023

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Directions to “ MS. DESTIN RANAE CORLEY ” Practice Location

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