| NPI | 1578108254 |
|---|---|
| Former Name | CARISSA A WEATHERLY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP142585) |
| Additional Taxonomies | 261QI0500X Clinic/Center, Infusion Therapy (Licence: TX F05190775) |
| Enumeration Date | 2019-11-17 |
| Last Update Date | 2023-05-24 |