Email received from: Diana.Flores@dchstx.org  Subject: CREDENTIALING- Mercedita N. Flynn FNP    Mercedita N. Flynn, FNP  NPI # 1619166188  Coastal Bend Urgent Care LLC  Tax ID # 81-1890349     Good morning Ahmed     In order to initiate the credentialing process for Mercedita with Driscoll Health Plan, please provide the following information to avoid delay in credentialing the provider.     ·         Attestation pages with current signature and date-Attached  ·         Addendum--Attached please fill in % of time supervised  ·         Copy of PAA/ Collaborating Agreement-attached or if you already have your own and it provides the information requested on our form you can send it in.  ·         Copy of current DEA-License- in CAQH its expired  Copy of current CLIA-per addendum* you have a CLIA in the office please provide a copy of certificate Texas Standardized Credentialing Application is missing required information in order to complete your application. See highlighted pages attached, review in its entirety for accuracy and fill in information. You can fill in attached pages or go online to CAQH. Once completed I can retrieve pages online. TSCA-page-5-call coverage normally  listed is the Supervising physician TSCA-page-6- Check Payable To-normally list the corporation name as it appears on W-9    I have attached forms needed, please provide the above required documents to process the application.     If you have any questions please contact me via email or by phone.     Thank you in advance for your cooperation.     Sincerely     Diana R. Flores  Credentialing Specialist  4525 Ayers St  Corpus Christi, TX 78415-1401  Office:  (361) 694-5563  Fax: (361) 808-2182  Email: diana.flores@dchstx.org  Website: www.driscollhealthplan.com