Provider Demographics
NPI:1730906165
Name:CARPENTER, KRISTEN MICHELE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MICHELE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6618 HOLFORD LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-2908
Mailing Address - Country:US
Mailing Address - Phone:609-954-2254
Mailing Address - Fax:
Practice Address - Street 1:5514 ALMA LN STE 200
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-4014
Practice Address - Country:US
Practice Address - Phone:703-827-3379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024186344207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine