Basic Information
| Provider Information | |||||||||
| NPI: | 1538242375 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FREEMAN | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | KUGEL | ||||||||
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| Credential: | FNP, CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7703 FLOYD CURL DR | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103583582 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 15500 W HWY 71 STE 100 | ||||||||
| Address2: | |||||||||
| City: | BEE CAVE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787382815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2817838162 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 09/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 245938 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 367A00000X | 245938 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 363L00000X | AP100429 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 130592211 | 05 | TX | MEDICAID |