Provider Demographics
NPI:1326549551
Name:VINSON, CAROLYN SUE (LVN)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:SUE
Last Name:VINSON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 COUNTY ROAD 109
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79556-3627
Mailing Address - Country:US
Mailing Address - Phone:325-439-8978
Mailing Address - Fax:
Practice Address - Street 1:117 COUNTY ROAD 109
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TX
Practice Address - Zip Code:79556-3627
Practice Address - Country:US
Practice Address - Phone:325-439-8978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210126164X00000X, 164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse