Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 1017 | TX |
N | 222Z00000X | Podiatrist | 1017 | TX |
Y | 224P00000X | Prosthetist | 1017 | TX |
NPI | 1154719094 |
---|---|
Provider Name | Mrs. Jackie Carver |
First Address | Spring, TX 77388-4787 |
Second Address | Spring, TX 77388-4787 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2014 |
Last Update Date | 30/12/2014 |