Provider Demographics
NPI:1003884842
Name:FAHEY, KAREN LEE (DNP, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LEE
Last Name:FAHEY
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26041-2202
Mailing Address - Country:US
Mailing Address - Phone:304-531-8154
Mailing Address - Fax:304-275-4798
Practice Address - Street 1:272 FRONTAGE ROAD
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:WV
Practice Address - Zip Code:26150
Practice Address - Country:US
Practice Address - Phone:512-800-9739
Practice Address - Fax:855-802-7617
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV25748363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0159874000Medicaid
P28544Medicare UPIN
FANP10494Medicare PIN