Provider Demographics
NPI:1962197558
Name:CARSTENSEN, JOSLYN KATRINA
Entity type:Individual
Prefix:
First Name:JOSLYN
Middle Name:KATRINA
Last Name:CARSTENSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3129 PARK NORTH DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79904-2414
Mailing Address - Country:US
Mailing Address - Phone:575-214-0077
Mailing Address - Fax:
Practice Address - Street 1:7814 CAROUSEL LN STE 210
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4212
Practice Address - Country:US
Practice Address - Phone:575-214-0077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10947133V00000X
TXDT86555133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered