Provider Demographics
NPI:1467448399
Name:WOLTERS, KAREN EVANS (MSN RN CFNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:EVANS
Last Name:WOLTERS
Suffix:
Gender:F
Credentials:MSN RN CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5000 PIMLICO DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-1520
Mailing Address - Country:US
Mailing Address - Phone:432-352-4498
Mailing Address - Fax:
Practice Address - Street 1:400 N GARFIELD ST
Practice Address - Street 2:SUITE 240
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5904
Practice Address - Country:US
Practice Address - Phone:432-683-2723
Practice Address - Fax:432-683-4907
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX597583363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A4509Medicaid