Provider Demographics
NPI:1760930465
Name:ROSE, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:ROSE
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 1:6565 BOBWHITE LN
Mailing Address - Street 2:
Mailing Address - City:FRENCH VILLAGE
Mailing Address - State:MO
Mailing Address - Zip Code:63036-1433
Mailing Address - Country:US
Mailing Address - Phone:618-340-2177
Mailing Address - Fax:
Practice Address - Street 1:5272 FLAT RIVER DR
Practice Address - Street 2:
Practice Address - City:PARK HILLS
Practice Address - State:MO
Practice Address - Zip Code:63601-2224
Practice Address - Country:US
Practice Address - Phone:773-431-0162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016010708363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology