Provider Demographics
NPI:1245743855
Name:SELF, KARON J (RN, CDE)
Entity Type:Individual
Prefix:
First Name:KARON
Middle Name:J
Last Name:SELF
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 SADDLEHORN DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-1920
Mailing Address - Country:US
Mailing Address - Phone:785-840-4794
Mailing Address - Fax:
Practice Address - Street 1:601 SW CORPORATE VW
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66615-1244
Practice Address - Country:US
Practice Address - Phone:785-273-2731
Practice Address - Fax:785-273-2346
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-48545-042163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator