Provider Demographics
NPI:1518114958
Name:RANSOM, KAREN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:RANSOM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:971 LAKELAND DR
Mailing Address - Street 2:STE 656
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4643
Mailing Address - Country:US
Mailing Address - Phone:601-366-6606
Mailing Address - Fax:601-366-6647
Practice Address - Street 1:971 LAKELAND DR
Practice Address - Street 2:STE 656
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4643
Practice Address - Country:US
Practice Address - Phone:601-366-6606
Practice Address - Fax:601-366-6647
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR623431363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSR623431OtherCERTIFIED FAMILY NURSE PRACTITIONER