Provider Demographics
NPI:1841469459
Name:KISSINGER, CARRIE A (LMT)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:A
Last Name:KISSINGER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32067-0267
Mailing Address - Country:US
Mailing Address - Phone:904-534-6644
Mailing Address - Fax:
Practice Address - Street 1:2256 HOPKINS ST
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5222
Practice Address - Country:US
Practice Address - Phone:904-534-6644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA49889174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist