Provider Demographics
NPI:1104043405
Name:MANNING, KAREN G (CNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:G
Last Name:MANNING
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-3144
Mailing Address - Country:US
Mailing Address - Phone:706-845-0500
Mailing Address - Fax:706-812-9315
Practice Address - Street 1:310 S LEWIS ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-3144
Practice Address - Country:US
Practice Address - Phone:706-845-0500
Practice Address - Fax:706-812-9315
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR077204363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAS24335Medicare UPIN
GA50BBCMXMedicare ID - Type Unspecified