Provider Demographics
NPI:1881922870
Name:WITHERSPOON, KAREN ANN (CCP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:WITHERSPOON
Suffix:
Gender:F
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3329 ROYAL LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-5062
Mailing Address - Country:US
Mailing Address - Phone:972-814-4809
Mailing Address - Fax:
Practice Address - Street 1:3329 ROYAL LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-5062
Practice Address - Country:US
Practice Address - Phone:972-814-4809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPF1059242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist