Provider Demographics
NPI:1982430740
Name:CARREON, PROMISE LOVE JOY B
Entity type:Individual
Prefix:
First Name:PROMISE LOVE JOY
Middle Name:B
Last Name:CARREON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 FIREOVED DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2524
Mailing Address - Country:US
Mailing Address - Phone:907-764-0111
Mailing Address - Fax:
Practice Address - Street 1:331 FIREOVED DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2524
Practice Address - Country:US
Practice Address - Phone:907-764-0111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator