Provider Demographics
NPI:1073713491
Name:SHACKELFORD, KAREN B (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:B
Last Name:SHACKELFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ELIZABETH
Other - Last Name:BERGSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:305A KEYWAY DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9572
Mailing Address - Country:US
Mailing Address - Phone:601-936-3663
Mailing Address - Fax:601-362-9806
Practice Address - Street 1:305A KEYWAY DR
Practice Address - Street 2:SUITE A
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9572
Practice Address - Country:US
Practice Address - Phone:601-936-3663
Practice Address - Fax:601-362-9806
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14931207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine