Provider Demographics
NPI:1497466429
Name:PERSON, KARNASHIA
Entity Type:Individual
Prefix:
First Name:KARNASHIA
Middle Name:
Last Name:PERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 CRESTONE LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-1478
Mailing Address - Country:US
Mailing Address - Phone:334-614-2967
Mailing Address - Fax:
Practice Address - Street 1:2053 WILMA RUDOLPH BLVD STE 2
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-6961
Practice Address - Country:US
Practice Address - Phone:334-614-2967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN204696335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0240166OtherBUSINESS LICENSE