Provider Demographics
NPI:1831355262
Name:BLOSSOM, KAREN (PA-C)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:BLOSSOM
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:933 BRADBURY DR SE
Mailing Address - Street 2:2222
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4374
Mailing Address - Country:US
Mailing Address - Phone:505-272-3120
Mailing Address - Fax:505-272-8060
Practice Address - Street 1:1001 MARTIN LUTHER KING AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4713
Practice Address - Country:US
Practice Address - Phone:505-272-2530
Practice Address - Fax:505-925-7849
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2014-08-21
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Provider Licenses
StateLicense IDTaxonomies
AZ3271363A00000X
NMPA2013-0050363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant