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NPI Code Detail

MEDICARE: THERESA CARLSON AGACNP-BC

MEDICARE: THERESA CARLSON AGACNP-BC
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
1363LA2100XAcute Care Nurse PractitionerAP129474TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1861864860
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESA CARLSON AGACNP-BC
Provider Business Mailing Address
First Line : 4708 ALLIANCE BLVD STE 600
Second Line :
City : PLANO
State : TX
Zip : 75093-5368
Country : US
Telephone Number : 469-467-0011
Fax Number : 469-467-4923
Provider Business Practice Location Address
First Line : 4708 ALLIANCE BLVD STE 600
Second Line :
City : PLANO
State : TX
Zip : 75093-5368
Country : US
Telephone Number : 469-467-0011
Fax Number : 469-467-4923
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2015
Last Update Date : 07/13/2020

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Directions to “ THERESA CARLSON AGACNP-BC” Practice Location

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