Provider Demographics
NPI:1164664348
Name:SEAGO, KAREN EDWARDS (NP)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:EDWARDS
Last Name:SEAGO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2550 FLOWOOD DR
Mailing Address - Street 2:SUITE 402
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9303
Mailing Address - Country:US
Mailing Address - Phone:601-936-3121
Mailing Address - Fax:601-936-3130
Practice Address - Street 1:187 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-4042
Practice Address - Country:US
Practice Address - Phone:601-932-8722
Practice Address - Fax:601-939-2623
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR701653363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSR701653OtherLICENSE
MS00118110Medicaid