Provider Demographics
NPI:1619221165
Name:FIFE, KAREN ELIZABETH (FNP)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:ELIZABETH
Last Name:FIFE
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 1:5430 FREDERICKSBURG RD STE 508
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3561
Mailing Address - Country:US
Mailing Address - Phone:210-614-5539
Mailing Address - Fax:
Practice Address - Street 1:5430 FREDERICKSBURG RD STE 508
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3561
Practice Address - Country:US
Practice Address - Phone:210-614-5539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-06
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR876914363LF0000X
AL1-165742363LF0000X
TX1140934363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01500883Medicaid
MS265480YJ5DMedicare PIN