Basic Information
| Provider Information | |||||||||
| NPI: | 1730257403 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BJORKMAN | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5939 HARRY HINES BLVD. | ||||||||
| Address2: | PROFESSIONAL OFFICE BUILDING 2, SUITE 600 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753905688 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146455505 | ||||||||
| FaxNumber: | 2146455639 | ||||||||
| Practice Location | |||||||||
| Address1: | 5939 HARRY HINES BLVD. | ||||||||
| Address2: | PROFESSIONAL OFFICE BUILDING 2, SUITE 600 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753905688 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146455505 | ||||||||
| FaxNumber: | 2146455639 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2006 | ||||||||
| LastUpdateDate: | 12/22/2015 | ||||||||
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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 | 363LF0000X | 507646 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 185568601 | 05 | TX | MEDICAID | 185568603 | 05 | TX | MEDICAID | 185568602 | 05 | TX | MEDICAID |