Individual
KIERSTEN RENE CARRICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7950 W JEFFERSON BLVD, SUTIE 2121, FORT WAYNE, IN 46804-4140
(260) 435-7937
(260) 435-7933
Mailing address
10351 DAWSONS CREEK BLVD, SUITE A-1, FORT WAYNE, IN 46825-1904
(260) 203-9600
(260) 739-9602
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1001557A
IN
Other
Enumeration date
05/30/2013
Last updated
12/19/2024
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