Provider Demographics
NPI:1801914775
Name:CARMODY, KAREN ANN (MSN, FNP-C)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:ANN
Last Name:CARMODY
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:ANN
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, FNP-C
Mailing Address - Street 1:4755 OGLETOWN STANTON RD
Mailing Address - Street 2:STE 1179
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19718-2200
Mailing Address - Country:US
Mailing Address - Phone:302-733-1000
Mailing Address - Fax:302-733-1633
Practice Address - Street 1:4755 OGLETOWN-STANTON ROAD
Practice Address - Street 2:SUITE 1179
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2200
Practice Address - Country:US
Practice Address - Phone:302-733-4626
Practice Address - Fax:302-733-1633
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0000157363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEAN0281OtherDE UNIFORM CONTROLLED SUB
DERXAPN3098OtherNURSE PRACT .PRESCRIBER #
DE0000705642Medicaid
DE0000705642Medicaid
DE0000705642Medicaid