Provider Demographics
NPI:1700525268
Name:DOMINICK, KAREN (PRSS)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:DOMINICK
Suffix:
Gender:F
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-6950
Mailing Address - Country:US
Mailing Address - Phone:304-305-0699
Mailing Address - Fax:
Practice Address - Street 1:118 WARREN AVE
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-6950
Practice Address - Country:US
Practice Address - Phone:304-860-0618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17-907175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist