Healthcare Provider Details

I. General information

NPI: 1780984393
Provider Name (Legal Business Name): CAROLINA ALEXANDRIA CARMICHAEL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16977 INTERSTATE 35 N STE 210
SCHERTZ TX
78154-1466
US

IV. Provider business mailing address

8711 VILLAGE DR STE 114
SAN ANTONIO TX
78217-5419
US

V. Phone/Fax

Practice location:
  • Phone: 210-656-5600
  • Fax:
Mailing address:
  • Phone: 210-297-2244
  • Fax: 210-337-2644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberTEMP
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA06889
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: