Provider Demographics
NPI:1992223135
Name:HARVIS, KAREN ANN (RN, MS, CS-P)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:HARVIS
Suffix:
Gender:F
Credentials:RN, MS, CS-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 SWIFT STREAM PL APT 202
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-4700
Mailing Address - Country:US
Mailing Address - Phone:443-938-7953
Mailing Address - Fax:
Practice Address - Street 1:10400 SWIFT STREAM PLACE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-4700
Practice Address - Country:US
Practice Address - Phone:443-938-7953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-08
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR069532163W00000X
MD0132540364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163W00000XNursing Service ProvidersRegistered Nurse