Provider Demographics
NPI:1407807811
Name:KOELEMAY, KAREN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:KOELEMAY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 EXETER RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2954
Mailing Address - Country:US
Mailing Address - Phone:901-818-2160
Mailing Address - Fax:901-682-9522
Practice Address - Street 1:1900 EXETER RD
Practice Address - Street 2:SUITE 210
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2954
Practice Address - Country:US
Practice Address - Phone:901-818-2160
Practice Address - Fax:901-682-9522
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN 10857367500000X
TNRN 139171163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04434872Medicaid
MO915186829Medicaid
AR127877701Medicaid
TN3633447Medicaid
TN4089877OtherBLUE CROSS
AR5T029OtherBLUE CROSS
P00127942OtherRAILROAD MEDICARE
AR5T029OtherBLUE CROSS