Provider Demographics
NPI:1427389857
Name:CARSWELL, KATHYRN DIANE
Entity Type:Individual
Prefix:MISS
First Name:KATHYRN
Middle Name:DIANE
Last Name:CARSWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8980 ARCADE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3363
Mailing Address - Country:US
Mailing Address - Phone:904-330-6716
Mailing Address - Fax:
Practice Address - Street 1:8980 ARCADE AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-3363
Practice Address - Country:US
Practice Address - Phone:904-330-6716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-25
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL360358001Medicaid