Provider Demographics
NPI:1629371646
Name:MOREHOUSE, KAREN LYNN
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:LYNN
Last Name:MOREHOUSE
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 1:2556 STONEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-5076
Mailing Address - Country:US
Mailing Address - Phone:407-227-3648
Mailing Address - Fax:407-896-8743
Practice Address - Street 1:2556 STONEVIEW RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-5076
Practice Address - Country:US
Practice Address - Phone:407-227-3648
Practice Address - Fax:407-896-8743
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL811719500Medicaid