Provider Demographics
NPI:1063996320
Name:CARNICLE, KATHERINE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:CARNICLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 PECAN
Mailing Address - Street 2:
Mailing Address - City:VAN VLECK
Mailing Address - State:TX
Mailing Address - Zip Code:77482-6341
Mailing Address - Country:US
Mailing Address - Phone:979-244-4899
Mailing Address - Fax:
Practice Address - Street 1:130 PECAN
Practice Address - Street 2:
Practice Address - City:VAN VLECK
Practice Address - State:TX
Practice Address - Zip Code:77482-6341
Practice Address - Country:US
Practice Address - Phone:979-244-4899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX545667163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse