Provider Demographics
NPI: | 1477500379 |
---|---|
Name: | KARST, GRETCHEN L (CRNA) |
Entity Type: | Individual |
Prefix: | |
First Name: | GRETCHEN |
Middle Name: | L |
Last Name: | KARST |
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: | PO BOX 551420 |
Mailing Address - Street 2: | |
Mailing Address - City: | FORT LAUDERDALE |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33355-1420 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 800-243-3839 |
Mailing Address - Fax: | 954-839-2569 |
Practice Address - Street 1: | 2701 N. DECATUR RD |
Practice Address - Street 2: | |
Practice Address - City: | DECATUR |
Practice Address - State: | GA |
Practice Address - Zip Code: | 30033-0000 |
Practice Address - Country: | US |
Practice Address - Phone: | 678-514-1991 |
Practice Address - Fax: | 678-514-1992 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-05-27 |
Last Update Date: | 2013-04-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
GA | 146979 | 367500000X |
GA | RN146979 | 367500000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
GA | 000549043A | Medicaid | |
GA | 000849043A | Medicaid | |
GA | 000849043A | Medicaid | |
GA | 000549043A | Medicaid | |
GA | 202I433665 | Medicare PIN |