Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP139529 | TX |
N | 363LC1500X | Nurse Practitioner - Community Health | 5011959 | NC |
NPI | 1386206977 |
---|---|
Provider Name | Karla Alexandra Cervantes |
First Address | Charlotte, NC 28208-5631 |
Second Address | Lubbock, TX 79404-2746 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2019 |
Last Update Date | 21/09/2020 |