Provider Demographics
NPI:1942288220
Name:DEAN, KAREN (CRNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36104-4424
Mailing Address - Country:US
Mailing Address - Phone:334-263-2301
Mailing Address - Fax:334-263-0881
Practice Address - Street 1:100 E VANDIVER BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36110-1812
Practice Address - Country:US
Practice Address - Phone:334-832-4338
Practice Address - Fax:334-832-9971
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-026442363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51517350OtherBCBS
AL630903046Medicaid
AL630900046Medicaid
AL630901046Medicaid
AL51044084OtherBCBS
AL51517348OtherBCBS
AL630902046Medicaid
AL630900046Medicaid
AL000044804Medicare ID - Type Unspecified