Provider Demographics
NPI:1750633251
Name:STACK, KAREN D (RN BSN MN)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:D
Last Name:STACK
Suffix:
Gender:F
Credentials:RN BSN MN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2793 CLAIRMONT RD NE
Mailing Address - Street 2:SUITE 213
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2700
Mailing Address - Country:US
Mailing Address - Phone:404-633-0545
Mailing Address - Fax:404-781-0779
Practice Address - Street 1:2793 CLAIRMONT RD NE
Practice Address - Street 2:SUITE 213
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2700
Practice Address - Country:US
Practice Address - Phone:404-633-0545
Practice Address - Fax:404-781-0779
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN047976163WA2000X, 163WC1600X, 163WD0400X, 163WN1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support