Provider Demographics
NPI:1326070541
Name:NELMS, KAREN W (CRNA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:W
Last Name:NELMS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:504 CLINTON CENTER DRIVE
Mailing Address - Street 2:CBO- SUITE 4300
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-5610
Mailing Address - Country:US
Mailing Address - Phone:601-496-9524
Mailing Address - Fax:601-815-0434
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-1000
Practice Address - Fax:601-815-0434
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901498367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-12357OtherBC BS OF AL
AL051551366Medicaid
MS05231510Medicaid
AL124769Medicaid
AL430068753OtherMEDICARE RAILROAD
AL51551366HILMedicare ID - Type Unspecified
AL102I435760Medicare PIN