Provider Demographics
NPI:1447915426
Name:SKERTCHLY, CAROLINA M (MSN, PNP-PC)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:M
Last Name:SKERTCHLY
Suffix:
Gender:F
Credentials:MSN, PNP-PC
Other - Prefix:
Other - First Name:CAROLINA
Other - Middle Name:SKERTCHLY
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN, PNP-PC
Mailing Address - Street 1:1719 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-5855
Mailing Address - Country:US
Mailing Address - Phone:469-300-5437
Mailing Address - Fax:469-619-8619
Practice Address - Street 1:1719 W 10TH ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-5855
Practice Address - Country:US
Practice Address - Phone:469-300-5437
Practice Address - Fax:469-619-8619
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1058117363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics