Provider Demographics
NPI:1235192360
Name:ACKLEY, KAREN ELIZABETH (FNP)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:ELIZABETH
Last Name:ACKLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:ELIZABETH
Other - Last Name:DEVISSER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:110 KINGSLEY LN
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-4614
Mailing Address - Country:US
Mailing Address - Phone:757-889-5735
Mailing Address - Fax:757-889-5742
Practice Address - Street 1:110 KINGSLEY LN
Practice Address - Street 2:SUITE 106
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-4614
Practice Address - Country:US
Practice Address - Phone:757-889-5735
Practice Address - Fax:757-889-5742
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201570363LF0000X
VA0024165653363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q23486Medicare UPIN
NC2592592Medicare ID - Type Unspecified