Provider Demographics
NPI:1386150621
Name:FLIPPIN, CARLATESHA KEANN (APRN)
Entity type:Individual
Prefix:
First Name:CARLATESHA
Middle Name:KEANN
Last Name:FLIPPIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9701 MEYER FOREST DR APT 9302
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-4321
Mailing Address - Country:US
Mailing Address - Phone:270-303-9598
Mailing Address - Fax:859-258-8610
Practice Address - Street 1:4208 ELLA BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-4231
Practice Address - Country:US
Practice Address - Phone:832-831-4660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-22
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1025473363LP0200X
KY3011948363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics