Provider Demographics
NPI:1922062603
Name:MEDLIN, KAREN F (CRNA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:F
Last Name:MEDLIN
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 1:601 HALTON RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3403
Mailing Address - Country:US
Mailing Address - Phone:864-250-6484
Mailing Address - Fax:864-250-6475
Practice Address - Street 1:5 STEVENS ST STE 200
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4528
Practice Address - Country:US
Practice Address - Phone:864-250-6484
Practice Address - Fax:864-250-6475
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1222367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN0625Medicaid
SC1153Medicare PIN
SC5965Medicare PIN
SCP00358272Medicare PIN
SCQ31190Medicare UPIN