Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 231457 | TX |
NPI | 1386606135 |
---|---|
Provider Name | Carol Mcdowell Tackett |
First Address | Garland, TX 75042-4617 |
Second Address | Richardson, TX 75082-3542 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 08/07/2007 |