Provider Demographics
NPI:1063449411
Name:CARMICHAEL, KRISTEN RICHESON (MD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:RICHESON
Last Name:CARMICHAEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 N MACARTHUR BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-2210
Mailing Address - Country:US
Mailing Address - Phone:972-253-2560
Mailing Address - Fax:972-253-4218
Practice Address - Street 1:6750 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2875
Practice Address - Country:US
Practice Address - Phone:972-253-2530
Practice Address - Fax:972-253-4218
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8638207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179404201Medicaid
TX179404203Medicaid
TXP01312775OtherRAILROAD MEDICARE
TX179404201Medicaid
TX179404201Medicaid