Provider Demographics
NPI:1073252656
Name:CARSON, AINSLEY GRACE (STUDENT)
Entity Type:Individual
Prefix:
First Name:AINSLEY
Middle Name:GRACE
Last Name:CARSON
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 N PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:KS
Mailing Address - Zip Code:67119-8258
Mailing Address - Country:US
Mailing Address - Phone:316-789-3877
Mailing Address - Fax:
Practice Address - Street 1:416 N PACIFIC ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:KS
Practice Address - Zip Code:67119-8258
Practice Address - Country:US
Practice Address - Phone:316-789-3877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer