Provider Demographics
NPI:1194152959
Name:MCLARTY-NEVERS, PAULINE WINSOME (ACNP)
Entity type:Individual
Prefix:MRS
First Name:PAULINE
Middle Name:WINSOME
Last Name:MCLARTY-NEVERS
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:PAULINE
Other - Middle Name:
Other - Last Name:MCLARTY-NEVERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ACNP-BC
Mailing Address - Street 1:1601 LANCASTER DR
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-2109
Mailing Address - Country:US
Mailing Address - Phone:817-576-6665
Mailing Address - Fax:817-576-6663
Practice Address - Street 1:7777 FOREST LANE,
Practice Address - Street 2:BUILDING B, SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75320
Practice Address - Country:US
Practice Address - Phone:972-566-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-10
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX654559363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care