Provider Demographics
NPI:1841037371
Name:BACON, KAREY ANNA (PMHNP, BSN, RN)
Entity type:Individual
Prefix:
First Name:KAREY
Middle Name:ANNA
Last Name:BACON
Suffix:
Gender:F
Credentials:PMHNP, BSN, RN
Other - Prefix:
Other - First Name:KAREY
Other - Middle Name:WEISMAN
Other - Last Name:EALS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6445 GREENE ST APT B304
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-3243
Mailing Address - Country:US
Mailing Address - Phone:267-437-5641
Mailing Address - Fax:
Practice Address - Street 1:6445 GREENE ST APT B304
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-3243
Practice Address - Country:US
Practice Address - Phone:267-437-5641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP030069363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health