Provider Demographics
NPI:1720133150
Name:RIEDE, KAREN ANNE (NP)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:ANNE
Last Name:RIEDE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-0047
Mailing Address - Country:US
Mailing Address - Phone:281-351-7243
Mailing Address - Fax:
Practice Address - Street 1:720 LAWRENCE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-6455
Practice Address - Country:US
Practice Address - Phone:281-351-7243
Practice Address - Fax:281-255-3016
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX432659363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ0130107OtherTX DPS LICENSE
MR1017866OtherDEA LICENSE