Healthcare Provider Details

I. General information

NPI: 1861670531
Provider Name (Legal Business Name): ANASTASIYA V CARNEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 S UNION BLVD STE 315
COLORADO SPRINGS CO
80910-3126
US

IV. Provider business mailing address

383 DAVIT AVE
JAMESTOWN RI
02835-1719
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-3700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA06481
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA 0003882
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number001001240
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0003882
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: