Provider Demographics
NPI:1841435252
Name:FARRIS, KAREN LEANNE (FNP-BC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LEANNE
Last Name:FARRIS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SINGLETON RIDGE RD
Mailing Address - Street 2:ATTN PATIENT ACCOUNTING
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-9142
Mailing Address - Country:US
Mailing Address - Phone:843-234-6946
Mailing Address - Fax:
Practice Address - Street 1:4022 POSTAL WAY STE C
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-3537
Practice Address - Country:US
Practice Address - Phone:843-903-4111
Practice Address - Fax:843-903-4242
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC164448363L00000X, 363LF0000X
SC18602363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1841435252Medicaid
SCNP2939Medicaid
NC2593458AMedicare PIN
NC1841435252Medicaid
NCNC5682AMedicare PIN
NCNCD538AMedicare PIN
NCNCD538BMedicare PIN
NC2593458BMedicare PIN
NCNCD538DMedicare PIN
NCNCD538EMedicare PIN
SCNP2939Medicaid
NCNCD538CMedicare PIN
NCNC5682BMedicare PIN
NCNC5682CMedicare PIN
SCSC28397772Medicare PIN
NC2593458Medicare PIN