Provider Demographics
NPI:1700146495
Name:BLACK, KAREN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:BLACK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16437 NE 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-2113
Mailing Address - Country:US
Mailing Address - Phone:360-384-8329
Mailing Address - Fax:360-384-8465
Practice Address - Street 1:3901 UNICK RD
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-9003
Practice Address - Country:US
Practice Address - Phone:360-384-8329
Practice Address - Fax:360-384-8465
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003189363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant