Provider Demographics
NPI:1043254741
Name:KARN, RICHARD C (PA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:KARN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 PROVIDENT DRIVE
Mailing Address - Street 2:STE A
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 PROVIDENT DRIVE
Practice Address - Street 2:STE A
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580
Practice Address - Country:US
Practice Address - Phone:574-372-7637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN100002495A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
11479416OtherCAQH
IN000000531688OtherANTHEM
IN192240EEEMedicare PIN
IN000000531688OtherANTHEM
IN668030VVMedicare PIN
11479416OtherCAQH
R04636Medicare UPIN
IN668020VVMedicare PIN
IN090430JJMedicare PIN