Individual
CARLY JO DIVINEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN FNP-C
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 606-4262
Mailing address
800 E DAWSON ST, TYLER, TX 75701-2036
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
899590
TX
363LF0000X
Family Nurse Practitioner
Primary
F06250973
TX
Other
Enumeration date
05/05/2025
Last updated
06/19/2025
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