Provider Demographics
NPI:1376683235
Name:PERSELY, KAREN REYNOLDS (BA, R EP T CNIM)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:REYNOLDS
Last Name:PERSELY
Suffix:
Gender:F
Credentials:BA, R EP T CNIM
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Mailing Address - Street 1:5420 WEST LOOP S STE 3100
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2119
Mailing Address - Country:US
Mailing Address - Phone:713-581-6950
Mailing Address - Fax:
Practice Address - Street 1:5420 WEST LOOP S STE 3100
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2119
Practice Address - Country:US
Practice Address - Phone:713-581-6950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX374246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX374OtherCNIM