Doctor Name: | CARLA ANN HAIRSTON |
NPI Number: | 1124020631 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN,FNP |
License Number: | 431310 |
Business Practice Address: | 932 University Dr Nacogdoches, TX - 75964 |
Business Phone Number: | 9365641188 |
Business Fax Number: | 9365604137 |
Mailing Address: | 932 University Drive, NACOGDOCHES |
State: | TX |
Postal Code: | 75964 |
Phone Number: | 9365641188 |
Fax Number: | 9365604137 |
NPI Enumeration Date: | 08/15/2005 |
NPI Last Update Date: | 07/15/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 431310 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |