Provider Demographics
NPI:1083793665
Name:NESTER, KAREN KAY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:KAY
Last Name:NESTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 LANG AVE, NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4597
Mailing Address - Country:US
Mailing Address - Phone:505-883-2574
Mailing Address - Fax:505-883-0725
Practice Address - Street 1:4901 LANG AVE, NE
Practice Address - Street 2:SUITE 100
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4597
Practice Address - Country:US
Practice Address - Phone:505-883-2574
Practice Address - Fax:505-883-0725
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM94-PA09363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R01438NMMedicare UPIN
NMR01438Medicare UPIN