Provider Demographics
NPI:1174190839
Name:FOLKESSON, KARLEE NICOLE
Entity Type:Individual
Prefix:
First Name:KARLEE
Middle Name:NICOLE
Last Name:FOLKESSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 W TUCSON AVE
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-5452
Mailing Address - Country:US
Mailing Address - Phone:619-246-3454
Mailing Address - Fax:
Practice Address - Street 1:208 W PINE AVE
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1343
Practice Address - Country:US
Practice Address - Phone:928-523-7147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist