Provider Demographics
NPI:1093168890
Name:MEDLOCK, KAREN DENISE (RN)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:DENISE
Last Name:MEDLOCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 WINDWARD PEAK CT
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-5003
Mailing Address - Country:US
Mailing Address - Phone:864-275-2251
Mailing Address - Fax:864-895-1144
Practice Address - Street 1:120 WINDWARD PEAK CT
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-5003
Practice Address - Country:US
Practice Address - Phone:864-275-2251
Practice Address - Fax:864-895-1144
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC93969163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics