Provider Demographics
NPI:1013204007
Name:MORELAND, KAREN S (PA)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:S
Last Name:MORELAND
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ANNETTE
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6600 BRYANT IRVIN RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132
Mailing Address - Country:US
Mailing Address - Phone:817-820-0011
Mailing Address - Fax:817-820-0073
Practice Address - Street 1:6600 BRYANT IRVIN RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132
Practice Address - Country:US
Practice Address - Phone:817-820-0011
Practice Address - Fax:817-820-0073
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07371363A00000X, 363AS0400X
OH50.005152RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB134569Medicare PIN
TXTXB134567Medicare PIN
TXTXB134568Medicare PIN
TXTXB159754Medicare PIN
TXTXB159753Medicare PIN