Basic Information
| Provider Information | |||||||||
| NPI: | 1386150621 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLIPPIN | ||||||||
| FirstName: | CARLATESHA | ||||||||
| MiddleName: | KEANN | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9701 MEYER FOREST DR APT 9302 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770964321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703039598 | ||||||||
| FaxNumber: | 8592588610 | ||||||||
| Practice Location | |||||||||
| Address1: | 4208 ELLA BLVD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770184231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8328314660 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2017 | ||||||||
| LastUpdateDate: | 04/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 1025473 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | 363LP0200X | 3011948 | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.