Provider Demographics
NPI:1821466814
Name:CARLSEN, CHRISTY
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:CARLSEN
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 1:520 TECHWOOD DR N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-8500
Mailing Address - Country:US
Mailing Address - Phone:859-236-9819
Mailing Address - Fax:859-236-2192
Practice Address - Street 1:520 TECHWOOD DR N
Practice Address - Street 2:SUITE 200
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-8500
Practice Address - Country:US
Practice Address - Phone:859-236-9819
Practice Address - Fax:859-236-2192
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA715363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant