Individual provider Active NPI

Carrie Lin Hernandez, APRN-C

  • Family Nurse Practitioner
  • Greenville, TX
National Provider Identifier
1295338978
Registry record updated Feb 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1074272 Issued in TX
Practice address
4221 Ridgecrest Rd Ste 107
Greenville, TX 75402-6015
Phone
(903) 454-9976
NPI assigned
Nov 17, 2020
Last updated
Feb 14, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 53-79817-091 KS
Family Nurse Practitioner 363LF0000X 1074272 TX Primary

Addresses

Primary practice location

4221 Ridgecrest Rd Ste 107
Greenville, TX 75402-6015

Mailing address

4055 Valley View LN Ste 700
Dallas, TX 75244-5045
Phone (972) 715-3800

Other practice location 1

4055 Valley View Ln Ste 700
Dallas, TX 75244-5045
Phone (972) 715-3800

Other names 1

  • Miss Carrie Lin Wisdom Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS, TX2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210923001488 KS Practitioner - Nurse Practitioner 3577960210 Reassigns benefits to 1 organization
I20231016000466 TX Practitioner - Nurse Practitioner 3577960210 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Greenville Pulmonary Associates,PAGroup PAC ID 8921912775, 3 clinicians

Practice addresses (Care Compare)

4221 Ridgecrest Rd
Suite 107
Greenville, TX 75402-6015
Phone (903) 454-9976

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
53-79817-091KSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Revive Family Care & Wellness LLC Family Current Accepting new patients
Greenville Pulmonary Associates,PA CurrentSince Jan 29, 2024 Accepting new patients
Signify Health Medical Associates, PLLC CurrentSince Sep 1, 2023 Accepting new patients
Signify Health Medical Associates of Kansas LLC CurrentSince Nov 2, 2022 Accepting new patients

Locations

801 E Douglas Ave
Fl 2
Wichita, KS 67202
Phone (316) 330-5353

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

4055 Valley View Ln
Ste 600
Dallas, TX 75244

4055 Valley View Ln
Ste 700
Dallas, TX 75244
Phone (469) 466-7420

4221 Ridgecrest Rd
Ste 107
Greenville, TX 75402
Phone (903) 454-9976

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1605571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707868800000",
    "number": "1295338978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4055 VALLEY VIEW LN STE 700",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752445045",
            "telephone_number": "972-715-3800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4221 RIDGECREST RD STE 107",
            "city": "GREENVILLE",
            "state": "TX",
            "postal_code": "754026015",
            "telephone_number": "903-454-9976"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4055 Valley View Ln Ste 700",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752445045",
            "country_code": "US",
            "telephone_number": "972-715-3800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HERNANDEZ",
        "first_name": "CARRIE",
        "middle_name": "LIN",
        "name_prefix": "Mrs.",
        "credential": "APRN-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-17",
        "last_updated": "2024-02-14",
        "certification_date": "2024-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KS",
            "license": "53-79817-091",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1074272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARRIE",
            "last_name": "WISDOM",
            "middle_name": "LIN",
            "prefix": "MISS",
            "credential": "LPN, RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Greenville, TX

Sources for this page

Verify at the official NPI Registry.