Provider Demographics
NPI:1063870269
Name:BORIS, CARRYE (NP)
Entity type:Individual
Prefix:
First Name:CARRYE
Middle Name:
Last Name:BORIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MEDICAL CENTER BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2888
Mailing Address - Country:US
Mailing Address - Phone:936-441-9680
Mailing Address - Fax:
Practice Address - Street 1:100 MEDICAL CENTER BLVD
Practice Address - Street 2:STE 200
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2888
Practice Address - Country:US
Practice Address - Phone:936-441-9680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130161363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner