Susan Renee Carlson, MSN, ANP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

565581 Issued in TX

Practice address

2740 N Hwy 360
Suite 100
Grand Prairie, TX 75050-6403

Phone

(972) 606-8300

Fax

(972) 606-4940

NPI assigned

May 25, 2006

Last updated

Feb 23, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

Interoperability endpoints

• Direct secure messaging: scarlson226325@direct.sw.org

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266883200000",
    "number": "1043266711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2740 N HWY 360",
            "address_2": "SUITE 100",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750506403",
            "telephone_number": "972-606-8300",
            "fax_number": "972-606-4940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2740 N HWY 360",
            "address_2": "SUITE 100",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750506403",
            "telephone_number": "972-606-8300",
            "fax_number": "972-606-4940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "SUSAN",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "MSN, ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-25",
        "last_updated": "2010-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "565581",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "TX",
            "license": "565581",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "156976601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Adult Health Nurse Practitioner in Grand Prairie, TX
• Providers in Grand Prairie, TX by specialty
• Adult Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.