Healthcare Provider Details

I. General information

NPI: 1013538172
Provider Name (Legal Business Name): KRISTINA ALEXA CARNEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FLEET FORCES COMMAND 1562 MITSCHER AVE SUITE 250
NORFOLK VA
23551-0001
US

IV. Provider business mailing address

860 N 25TH ST
PHILADELPHIA PA
19130-1359
US

V. Phone/Fax

Practice location:
  • Phone: 757-836-3644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101279648
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: