Provider Demographics
NPI:1932391174
Name:CARNEVALE, KRISTINA KAY (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:KAY
Last Name:CARNEVALE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10840 TEXAS HEALTH TRL
Mailing Address - Street 2:SUITE 250
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-6846
Mailing Address - Country:US
Mailing Address - Phone:817-750-1310
Mailing Address - Fax:817-750-1311
Practice Address - Street 1:10840 TEXAS HEALTH TRL
Practice Address - Street 2:SUITE 250
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-6846
Practice Address - Country:US
Practice Address - Phone:817-306-5630
Practice Address - Fax:817-306-5631
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM3116207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196806702Medicaid
TX196806702Medicaid