Provider Demographics
NPI:1942251756
Name:SMITH, KAREN (NP)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
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 1028
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47547-1028
Mailing Address - Country:US
Mailing Address - Phone:812-481-1088
Mailing Address - Fax:812-481-8497
Practice Address - Street 1:709 W 9TH ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-2609
Practice Address - Country:US
Practice Address - Phone:812-481-8460
Practice Address - Fax:812-481-8465
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001275363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200467630Medicaid
INP39020Medicare UPIN
IN200467630Medicaid