Provider Demographics
NPI:1003688706
Name:CHURCH, KAREN (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:CHURCH
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:ROLLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8257 FOREST RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WOODWAY
Mailing Address - State:TX
Mailing Address - Zip Code:76712-2405
Mailing Address - Country:US
Mailing Address - Phone:214-766-9649
Mailing Address - Fax:
Practice Address - Street 1:611 W HWY 6 STE 101
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-7545
Practice Address - Country:US
Practice Address - Phone:254-755-4582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1134942363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty