Provider Demographics
NPI:1215181789
Name:CLYBURN, KAREN ELAINE (APRN)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:ELAINE
Last Name:CLYBURN
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 1:40 BALDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:LUGOFF
Mailing Address - State:SC
Mailing Address - Zip Code:29078-9406
Mailing Address - Country:US
Mailing Address - Phone:803-408-3262
Mailing Address - Fax:803-408-8895
Practice Address - Street 1:645 S SEVENTH ST
Practice Address - Street 2:
Practice Address - City:MC BEE
Practice Address - State:SC
Practice Address - Zip Code:29101-7101
Practice Address - Country:US
Practice Address - Phone:843-335-8291
Practice Address - Fax:843-335-8731
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3637363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3637OtherLIC
SC363LF0000XOtherTAXONOMY