Provider Demographics
NPI:1487286647
Name:CARSON, KATIANNA JUANITA (RN)
Entity type:Individual
Prefix:
First Name:KATIANNA
Middle Name:JUANITA
Last Name:CARSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 MCRAE RD LOT 18
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-2593
Mailing Address - Country:US
Mailing Address - Phone:907-268-8666
Mailing Address - Fax:
Practice Address - Street 1:2409 MCRAE RD LOT 18
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517-2593
Practice Address - Country:US
Practice Address - Phone:907-268-8666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK147472163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty