Basic Information
| Provider Information | |||||||||
| NPI: | 1063870269 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BORIS | ||||||||
| FirstName: | CARRYE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 MEDICAL CENTER BLVD | ||||||||
| Address2: | STE 200 | ||||||||
| City: | CONROE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773042888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9364419680 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 100 MEDICAL CENTER BLVD | ||||||||
| Address2: | STE 200 | ||||||||
| City: | CONROE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773042888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9364419680 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2016 | ||||||||
| LastUpdateDate: | 02/02/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP130161 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.