Provider Demographics
NPI:1558841940
Name:ENNEKING, KAREN (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:ENNEKING
Suffix:
Gender:F
Credentials:PMHNP-BC
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 327
Mailing Address - Street 2:
Mailing Address - City:MATHEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23109-0327
Mailing Address - Country:US
Mailing Address - Phone:757-725-3041
Mailing Address - Fax:804-725-3510
Practice Address - Street 1:10978 BUCKLEY HALL ROAD
Practice Address - Street 2:
Practice Address - City:MATHEWS
Practice Address - State:VA
Practice Address - Zip Code:23109
Practice Address - Country:US
Practice Address - Phone:047-253-0418
Practice Address - Fax:804-725-3510
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176017163WG0600X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WG0600XNursing Service ProvidersRegistered NurseGerontology