Provider Demographics
NPI:1356715478
Name:GENTRY, KAREN ODELL (LPN)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ODELL
Last Name:GENTRY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 SHUGART RD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2467
Mailing Address - Country:US
Mailing Address - Phone:706-270-5100
Mailing Address - Fax:706-270-5066
Practice Address - Street 1:900 SHUGART RD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2467
Practice Address - Country:US
Practice Address - Phone:706-270-5100
Practice Address - Fax:706-270-5066
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN042495164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse