Provider Demographics
NPI:1720041791
Name:MEINERSHAGEN, KAREN K (CRNA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:K
Last Name:MEINERSHAGEN
Suffix:
Gender:F
Credentials:CRNA
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 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:801 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2733
Practice Address - Country:US
Practice Address - Phone:682-885-4054
Practice Address - Fax:682-885-7497
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX669670367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140478206OtherCSHCN
TX137345809OtherMEDICAID GROUP NUMBER
TX140442853OtherCSHCN GROUP NUMBER
TX00N47FOtherMEDICARE GROUP NUMBER
TX140478205Medicaid
TX8J9841Medicare PIN