Provider Demographics
NPI:1437156791
Name:NORTHERN, DANA KAREN (MD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:KAREN
Last Name:NORTHERN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276-0729
Mailing Address - Country:US
Mailing Address - Phone:270-725-9606
Mailing Address - Fax:270-725-9643
Practice Address - Street 1:1405 NASHVILLE ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-8850
Practice Address - Country:US
Practice Address - Phone:270-725-9606
Practice Address - Fax:270-725-9643
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY21468207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000068666OtherKENTUCKY BLUE CROSS
KY64214687Medicaid
KY1612301Medicare ID - Type Unspecified
KY64214687Medicaid