Provider Demographics
NPI:1982853198
Name:CARSON, MICHAEL KIT (MHPP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:KIT
Last Name:CARSON
Suffix:
Gender:M
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 LINWOOD DR.
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4520
Mailing Address - Country:US
Mailing Address - Phone:870-236-5880
Mailing Address - Fax:870-236-5757
Practice Address - Street 1:2420 LINWOOD DR.
Practice Address - Street 2:SUITE 2
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72401-4520
Practice Address - Country:US
Practice Address - Phone:870-236-5880
Practice Address - Fax:870-236-5757
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator