Individual
CARISSA MARIE KICINSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4009 BARRETT DR STE 100, RALEIGH, NC 27609-6616
(919) 848-0132
Mailing address
9228 YARDLEY TOWN DR, WAKE FOREST, NC 27587-8095
(716) 982-4981
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-06929
NC
363A00000X
Physician Assistant
—
—
Other
Enumeration date
01/04/2017
Last updated
10/12/2020
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