Provider Demographics
NPI:1952813123
Name:BALTAZAR GOMEZ, KAREN PRISCILLA (APRN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:PRISCILLA
Last Name:BALTAZAR GOMEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:405 COUNTY ROAD 4923
Mailing Address - Street 2:
Mailing Address - City:BLOOMBURG
Mailing Address - State:TX
Mailing Address - Zip Code:75556-4186
Mailing Address - Country:US
Mailing Address - Phone:214-551-9191
Mailing Address - Fax:903-728-5489
Practice Address - Street 1:405 COUNTY ROAD 4923
Practice Address - Street 2:
Practice Address - City:BLOOMBURG
Practice Address - State:TX
Practice Address - Zip Code:75556-4186
Practice Address - Country:US
Practice Address - Phone:214-551-9191
Practice Address - Fax:903-728-5489
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-28
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP135628363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner