| Carmen Pemberton Pllc | |
|
1135 S Main St Grapevine TX 76051-7533 | |
| (817) 416-7500 | |
| (817) 416-7565 |
| Full Name | Carmen Pemberton Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1135 S Main St, Grapevine, Texas |
| Authorized Official Name and Position | Carmen Loren Pemberton (PSYCHIATRIC NURSE PRACTIONER) |
| Authorized Official Contact | 8174167500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carmen Pemberton Pllc 1135 S Main St Grapevine TX 76051-7533 Ph: (817) 416-7500 | Carmen Pemberton Pllc 1135 S Main St Grapevine TX 76051-7533 Ph: (817) 416-7500 |
| NPI Number | 1568883858 |
|---|---|
| Provider Enumeration Date | 01/03/2014 |
| Last Update Date | 01/03/2014 |
| Medicare PECOS PAC ID | 3274763479 |
|---|---|
| Medicare Enrollment ID | O20140310001267 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568883858 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 590614 (Texas) | Primary |
| Provider Name | Carmen L Pemberton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407140916 PECOS PAC ID: 6608033469 Enrollment ID: I20120206000703 |
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