Provider Demographics
NPI:1881852416
Name:PUGMIRE, KAREN Y (APRN)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:Y
Last Name:PUGMIRE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:KAREN
Other - Middle Name:Y
Other - Last Name:PETERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:3697 GRAHAMRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039
Mailing Address - Country:US
Mailing Address - Phone:404-441-4723
Mailing Address - Fax:
Practice Address - Street 1:303 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312
Practice Address - Country:US
Practice Address - Phone:404-265-4198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN097978363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily