Provider Demographics
NPI:1770834475
Name:CORKERN, CARLEN (PA)
Entity type:Individual
Prefix:
First Name:CARLEN
Middle Name:
Last Name:CORKERN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 SILVERON APT 1309
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-4106
Mailing Address - Country:US
Mailing Address - Phone:225-938-9330
Mailing Address - Fax:
Practice Address - Street 1:9456 STATE HIGHWAY 121
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-6067
Practice Address - Country:US
Practice Address - Phone:214-817-4225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-21
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200570363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant