Provider Demographics
NPI:1093785800
Name:LIKINS, KAREN FAYE (APRN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:FAYE
Last Name:LIKINS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 WOLFORD AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:42539-3187
Mailing Address - Country:US
Mailing Address - Phone:606-787-8438
Mailing Address - Fax:606-787-8925
Practice Address - Street 1:187 WOLFORD AVE
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:42539-3187
Practice Address - Country:US
Practice Address - Phone:606-787-8438
Practice Address - Fax:606-787-8925
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2337P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78002078Medicaid
KY78002078Medicaid
KYS33521Medicare UPIN