Provider Demographics
NPI:1053678706
Name:CARDWELL, KAREN MIRANDA (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:MIRANDA
Last Name:CARDWELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 ALDEN GLEN DR
Mailing Address - Street 2:
Mailing Address - City:MOODY
Mailing Address - State:AL
Mailing Address - Zip Code:35004-3277
Mailing Address - Country:US
Mailing Address - Phone:205-223-4646
Mailing Address - Fax:
Practice Address - Street 1:1011 ALDEN GLEN DR
Practice Address - Street 2:
Practice Address - City:MOODY
Practice Address - State:AL
Practice Address - Zip Code:35004-3277
Practice Address - Country:US
Practice Address - Phone:205-223-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-115086363LA2200X
AL2011019100363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health