Provider Demographics
NPI:1699854877
Name:CARLSON-MCCARTHY, KRISTEN KAE (CRNA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:KAE
Last Name:CARLSON-MCCARTHY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20955 S23 HWY
Mailing Address - Street 2:
Mailing Address - City:LACONA
Mailing Address - State:IA
Mailing Address - Zip Code:50139-8861
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20955 S23 HWY
Practice Address - Street 2:
Practice Address - City:LACONA
Practice Address - State:IA
Practice Address - Zip Code:50139-8861
Practice Address - Country:US
Practice Address - Phone:515-229-3393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD-073435367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered