1750980363 NPI number — MRS. CARLA LARUE MOSBY APRN, FNP

Table of content: MRS. CARLA LARUE MOSBY APRN, FNP (NPI 1750980363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750980363 NPI number — MRS. CARLA LARUE MOSBY APRN, FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOSBY
Provider First Name:
CARLA
Provider Middle Name:
LARUE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN, FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750980363
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10150 BOWLING GREEN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75035-6984
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-551-5154
Provider Business Mailing Address Fax Number:
877-789-2967

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 S NOLEN DR STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHLAKE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76092-9167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-851-1250
Provider Business Practice Location Address Fax Number:
817-424-3491
Provider Enumeration Date:
10/23/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  1011154 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 1011154 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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