Provider Demographics
NPI:1093203861
Name:PEDERSEN, CARRIE (FNP)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8195 CUSTER RD STE 110
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-3195
Mailing Address - Country:US
Mailing Address - Phone:214-666-6259
Mailing Address - Fax:855-618-2235
Practice Address - Street 1:606 S SEVEN POINTS DR STE 9
Practice Address - Street 2:
Practice Address - City:SEVEN POINTS
Practice Address - State:TX
Practice Address - Zip Code:75143-9117
Practice Address - Country:US
Practice Address - Phone:214-666-6259
Practice Address - Fax:855-618-2235
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137359363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily