Provider Demographics
NPI:1568903326
Name:SKIDMORE, KAREN OVIDE (FNP-C)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:OVIDE
Last Name:SKIDMORE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5189 WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SORRENTO
Mailing Address - State:LA
Mailing Address - Zip Code:70778-3430
Mailing Address - Country:US
Mailing Address - Phone:985-513-1655
Mailing Address - Fax:
Practice Address - Street 1:1014 SAINT CLAIR BLVD STE 3000
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-5023
Practice Address - Country:US
Practice Address - Phone:225-743-2444
Practice Address - Fax:225-743-2448
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09244363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily