Provider Demographics
NPI:1487412516
Name:CARLSON, KASIE LYNN (DOM, AP, LAC)
Entity type:Individual
Prefix:
First Name:KASIE
Middle Name:LYNN
Last Name:CARLSON
Suffix:
Gender:F
Credentials:DOM, AP, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 2ND ST S STE A
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-4054
Mailing Address - Country:US
Mailing Address - Phone:727-744-4245
Mailing Address - Fax:
Practice Address - Street 1:405 2ND ST S STE A
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-4054
Practice Address - Country:US
Practice Address - Phone:727-744-4245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2067171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist