Provider Demographics
NPI:1083043913
Name:TREASURE, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:TREASURE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13524 PORTER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-1660
Mailing Address - Country:US
Mailing Address - Phone:704-807-7206
Mailing Address - Fax:704-432-1432
Practice Address - Street 1:13524 PORTER CREEK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-1660
Practice Address - Country:US
Practice Address - Phone:704-807-7206
Practice Address - Fax:704-432-1432
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006556363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health