Provider Demographics
NPI:1174174692
Name:CARLSON, KIRSTEN JOY (AGNP)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:JOY
Last Name:CARLSON
Suffix:
Gender:F
Credentials:AGNP
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 58538
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-8538
Mailing Address - Country:US
Mailing Address - Phone:281-724-4711
Mailing Address - Fax:832-632-1417
Practice Address - Street 1:905 W MEDICAL CENTER BLVD STE 103
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4009
Practice Address - Country:US
Practice Address - Phone:281-724-4711
Practice Address - Fax:832-632-1417
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145215363LG0600X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology