Provider Demographics
NPI:1679516777
Name:ANDERSON, KAREN BEALE (FNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:BEALE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:LYNN
Other - Last Name:BEALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:460 MAIL BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406
Mailing Address - Country:US
Mailing Address - Phone:912-644-5300
Mailing Address - Fax:912-644-3369
Practice Address - Street 1:105 ROCKY FORD RD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:GA
Practice Address - Zip Code:30467-2027
Practice Address - Country:US
Practice Address - Phone:912-564-7133
Practice Address - Fax:912-564-2619
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN101306363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S48323Medicare UPIN