Provider Demographics
NPI:1023250891
Name:CARRELL, COLLEEN S (RN MSN CPNP)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:S
Last Name:CARRELL
Suffix:
Gender:F
Credentials:RN MSN CPNP
Other - Prefix:MRS
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:CARRELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:204 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4822
Mailing Address - Country:US
Mailing Address - Phone:361-664-0145
Mailing Address - Fax:361-664-2248
Practice Address - Street 1:621 E SINTON ST
Practice Address - Street 2:
Practice Address - City:SINTON
Practice Address - State:TX
Practice Address - Zip Code:78387-2801
Practice Address - Country:US
Practice Address - Phone:361-364-4486
Practice Address - Fax:361-364-7385
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX593952363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86N541OtherHFCA
147334001OtherTPI
P41900Medicare UPIN