Provider Demographics
NPI:1164695227
Name:PUCKETT, KAREN REECE (MSN, NP-C)
Entity Type:Individual
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First Name:KAREN
Middle Name:REECE
Last Name:PUCKETT
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Gender:F
Credentials:MSN, NP-C
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Mailing Address - Street 1:114W MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292-6773
Mailing Address - Country:US
Mailing Address - Phone:336-249-8760
Mailing Address - Fax:336-249-2710
Practice Address - Street 1:1550 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2202
Practice Address - Country:US
Practice Address - Phone:336-258-2031
Practice Address - Fax:336-258-2037
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2015-11-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC102692363LF0000X
VA0024168075363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1164695227Medicaid
NC454639427OtherTAX ID
VAB667OtherGROUP PTAN