Provider Demographics
NPI:1366641847
Name:WEDLOCK, KAREN ANN (RN,CDE)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:ANN
Last Name:WEDLOCK
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 1:901 HEARTLAND RD.,
Mailing Address - Street 2:STE. 4860
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-6202
Mailing Address - Country:US
Mailing Address - Phone:816-271-6700
Mailing Address - Fax:816-271-6701
Practice Address - Street 1:901 HEARTLAND RD.,
Practice Address - Street 2:STE. 4860
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-6202
Practice Address - Country:US
Practice Address - Phone:816-271-6700
Practice Address - Fax:816-271-6701
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO109982163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator